Background:The larger size of the currently available transesophageal echocardiography (TEE) probes limits their use to relatively older infants undergoing cardiac surgery. In very young neonates and infants, epicardial echocardiogram is used to assess postoperative residual defects. Recently, a miniaturized microTEE probe compatible in neonates has been introduced for clinical use. We evaluated the use of this probe in small infants undergoing cardiac surgery.Materials and Methods:Thirty-three consecutive neonates and infants undergoing cardiac surgery at our institution were included in the study. Intraoperative echocardiography with Philips s8-3t microTEE probe done using IE33 platform was utilized to study the preoperative anatomy and assess postoperative results.Results:Thirty-three patients aged 3 days-2 years (mean 5.1 months) and weighing 2.5-11 kg (mean 4.4 kg) underwent perioperative evaluation using the microTEE probe. Good quality two-dimensional and color Doppler images were obtained in all patients. There were no complications related to the probe insertion or manipulation. The findings on microTEE led to revision of surgery in five patients. Certain echocardiographic parameters that could never be recorded with epicardial echocardiogram could be easily seen in microTEE.Conclusion:On preliminary evaluation, the microTEE probe provided good quality images in very small infants who were not amenable for transesophageal echocardiographic evaluation so far. The probe could be used safely in small infants without complications. It appears to be a promising imaging modality in the perioperative assessment of young infants undergoing cardiac surgery, in whom intraoperative epicardial echocardiography is currently the only tool.

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Introduction. Radiofrequency (RF) ablation is a well-established alternative treatment for primary and secondary lung tumours (1). It is performed in patients who are deemed unsuitable for, or would prefer not to undergo, surgery (2). At present, there is little data or consensus in the literature describing the anaesthetic management of this high-risk cohort of patients in the immediate perioperative period. Method. We describe a case series from our institution of 100 patients over a period of 5 years (2008-2013) who underwent RF ablation for primary lung malignancy under general anaesthesia. Preoperative lung function tests revealed a mean forced expiratory volume in one second (FEV1) of 1.49 litres (range 0.54-3.29L) and a mean % predicted value of 64% (range 25.3-124.1%). 51 patients (51% total patients) had FEV1 o60% of predicted value and of these, 19 patients (19% total patients) had FEV1 o40% of predicted value. The mean patient age was 72. All patients were intubated with single-lumen endotracheal tubes and had positivepressure ventilation for the duration of the case. Anaesthesia was maintained with a mixture of oxygen, air and sevoflurane. Intraoperative analgesia was opiate based in the form of a remifentanil infusion. Results. Immediate extubation post-procedure was achieved in over 95% of these cases. Post-operative recovery was in a highdependency unit setting for a period of 24-72 hours. Our rate of reintubation for respiratory failure and the subsequent requirement of admission to ICU remained low at less than 5%. Discussion. Poor baseline lung function tests can be associated with postoperative pulmonary complications [3], namely respiratory failure requiring re-intubation and prolonged stay in an intensive care setting. Despite the presence of multiple co-morbidities in this group of patients, our case series demonstrated a low rate of anaesthetic complications in patients undergoing RF ablation for pulmonary malignancy under general anaesthesia.

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