Objective: Macroglossia is a characteristic feature of Beckwith-Wiedemann syndrome (BWS), commonly treated with reduction glossectomy to restore form and function. There exists no consensus on the perioperative management of these patients undergoing tongue reduction surgery, including anecdotal information regarding how long postoperative intubation should be maintained. The aim of this study is to evaluate the necessity of prolonged postoperative intubation in patients receiving tongue reduction surgery via the surgical and anesthetic management methods at our center. Design: Retrospective case series. Setting: Institutional care at Level I Children’s Hospital. Participants: All children less than 18 years old with BWS and congenital macroglossia who underwent tongue reduction surgery over 5 consecutive years at our center (N = 24). Interventions: Tongue reduction surgery via the “W” technique. Main Outcome Measures: Success of immediate postoperative extubation and related surgical complications. Results: Immediate, uncomplicated postoperative extubation was successfully performed in all patients who received tongue reduction surgery for congenital macroglossia. Conclusions: Prolonged postoperative intubation for tongue reduction surgery may not be necessary as immediate, uncomplicated postoperative extubation was achieved in 100% of patients who received tongue reduction surgery at our center.

Anomalous Aortic Origin of a Coronary Artery (AAOCA) is a rare congenital cardiac condition with potentially lethal consequences. Variants of this condition accounts for the second leading cause of sudden cardiac death in children and adolescents. The incidence of detection of these anomalies is rising due to the improvement in imaging techniques. From our literature search, there are a few cases reported in the surgical journals, but none is about the anesthesia management. We report a case of AAOCA repair of a previously attempted and failed repair. In summary, anesthesia management of AAOCA depends on the type, anatomy, and pathophysiology of the anomaly. This patient's previous repair with graft resulted in a competing flow between her native RCA and the right internal mammary artery graft. Understanding and close monitoring of this flow dynamic is the key to manage such patients.

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