Cardiac arrest during excision of a huge sacrococcygeal teratoma - A report of two cases -

Abstract

Resection of large sacrococcygeal teratomas (SCTs) in premature neonates has been associated with significant perinatal mortality, making this a high risk procedure requiring careful anesthetic management. Most deaths during resection of SCTs are due to cardiac arrest caused by electrolyte imbalances, such as hyperkalemia, and massive bleeding during surgery. We describe two premature neonates who experienced cardiac arrest, one due to hyperkalemia and the other not due to hyperkalemia, during excision of large, prenatally diagnosed SCTs. We present here the considerations for anesthesia in premature neonates with huge SCTs.

Anesthetic Management of Sacrococcygeal Teratoma- A Case Report

“…The most common operation table deaths are due to sudden high blood loss and electrolyte imbalance. [7] Distal motor deficit and neurological sequel like bladder dysfunction may occur after resection. [8] Extubation and ICU admission should be planned according to the blood loss, duration of surgery, body temperature and hemodynamic condition of patient.…”

Thoracoabdominal and General Surgery

“…It is essential to make preparations for major blood loss with crossmatched fresh blood and blood products. Intraoperative cardiac arrest has been reported from hyperkalemia and hypocalcemia associated with a rapid, massive transfusion, especially when transfused rapidly through a central venous catheter, and hyperkalemia has been associated with surgical manipulation of a necrotic tumor [ 228 ]. Blood should be transfused slowly, preferably through peripheral IV access (not through a central line), especially if the blood is old.…”

Giant sacrococcygeal teratoma: Management concerns with reporting of a rare occurrence of venous air embolism

“…Difficulty in ventilation is known with such a large mass in the prone position which was eased in our case by repositioning which could be the reason for hypoxia and hypoventilation. [ 3 ] The temperature regulation is very vital in view of disproportionately large exposed surgical field to the body surface area with limited reserves of the neonate, to prevent coagulopathy and delayed recovery due to hypothermia. [ 3 ] Massive transfusion and the handling of the tumor may result in tumor lysis syndrome with hyperkalemia leading to cardiac arrest.…”

“…[ 3 ] The temperature regulation is very vital in view of disproportionately large exposed surgical field to the body surface area with limited reserves of the neonate, to prevent coagulopathy and delayed recovery due to hypothermia. [ 3 ] Massive transfusion and the handling of the tumor may result in tumor lysis syndrome with hyperkalemia leading to cardiac arrest. [ 3 4 ] However, hyperkalemia was not noted, but hypocalcemia due to massive transfusion was adequately treated with injection calcium gluconate.…”

“…[ 3 ] Massive transfusion and the handling of the tumor may result in tumor lysis syndrome with hyperkalemia leading to cardiac arrest. [ 3 4 ] However, hyperkalemia was not noted, but hypocalcemia due to massive transfusion was adequately treated with injection calcium gluconate. Resection of such a large vascular tumor with opened sinuses was perhaps the reason for the air entrapment in our case and lead to an episode of venous air embolism not commonly reported in literature with SCT.…”