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Journal of Anesthesia

, Volume 24, Issue 6, pp 951–954 | Cite as

Complications with massive sacrococcygeal tumor resection on a premature neonate

  • Edwin AbrahamEmail author
  • Tariq Parray
  • Abid Ghafoor
Clinical Report

Abstract

Resection of large sacrococcygeal teratomas (SCT) in neonates can pose many anesthetic challenges. The pathophysiology of the SCT determines the varying management. We present a case report of a 34-week newborn with a massive Altman type 3 SCT. The surgery was delayed 2 days because of hyperkalemia; however, as a result of continued tumor lysis the patient’s condition had worsened with little improvement of the potassium level. During the surgery, the patient had issues of bleeding needing massive transfusion. Ventilation was also difficult at times because of the massive tumor resting on the chest, resulting in respiratory acidosis. We also had difficulty in maintaining the temperature. This patient did well after the surgery and was discharged home. We address here the anesthetic issues involved in the perioperative care management of a premature infant with a massive SCT.

Keywords

Sacrococcygeal teratoma Tumor lysis Hyperkalemia 

Notes

Conflict of interest

None.

References

  1. 1.
    Tran K, Flake A, Kalawadia N, Maxwell L, Rehman M. Emergent excision of a prenatally diagnosed sacrococcygeal teratoma. Paediatr Anaesth. 2008;18:431–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Perrelli L, D’Urzo C, Manzoni C, Pintus C, Santis M, Masini L, Noia G. Sacrococcygeal teratoma outcome and management. An analysis of 17 cases. J Perinat Med. 2002;30:178–84.CrossRefGoogle Scholar
  3. 3.
    Hase T, Kodama M, Kishida A, Shimadera S, Aotani H, Shimada M, Yamamoto Y, Noda Y, Okabe H. Techniques available for the management of massive sacrococcygeal teratomas. Pediatr Surg Int. 2001;17:232–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Galinkin J, Schwarz U, Motoyama E. Anesthesia for fetal surgery. In: Smith RM, editor. Anesthesia for infants and children. 7th ed. St. Louis: Mosby; 2006. p. 555–6.Google Scholar
  5. 5.
    Rescorla F, Sawin R, Coran A, Dillon P, Azizkhan R. Long-term outcome for infants and children with sacrococcygeal teratoma: a report from the Childrens Cancer Group. J Pediatr Surg. 1998;33:171–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Hedrick H, Flake A, Crombleholme T, Howell L, Johnson M, Wilson R, Adzick N. Sacrococcygeal teratoma: prenatal assessment, fetal intervention, and outcome. J Pediatr Surg. 2004;39:430–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Reinoso-Barbero F, Sepulveda I, Perez-Ferrer A, De Andres A. Cardiac arrest secondary to hyperkalemia during surgery for a neonatal giant sacrococcygeal teratoma. Paediatr Anaesth. 2009;19:712–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Fadler K, Askin D. Sacrococcygeal teratoma in the newborn: a case study of prenatal management and clinical intervention. Neonatal Netw. 2008;27:185–91.PubMedGoogle Scholar
  9. 9.
    Girisch M, Rauch R, Carbon R, Habash T, Hofbeck M. Refractory bleeding following major surgery of a giant sacrococcygeal teratoma in a premature infant: successful use of recombinant factor VIIa. Eur J Pediatr. 2004;163:118–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Robertson F, Crombleholme T, Frantz I, Shephard B, Bianchi D, D’Alton M. Devascularization and staged resection of giant sacrococcygeal teratoma in the premature infant. J Pediatr Surg. 1995;30:309–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Jona J. Progressive tumor necrosis and lethal hyperkalemia in a neonate with a sacrococcygeal teratoma. J Perinat Med. 1999;19:538–40.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2010

Authors and Affiliations

  1. 1.Department of Pediatric Anesthesiology and Pain Medicine, Arkansas Children’s HospitalUniversity of Arkansas for Medical SciencesLittle RockUSA

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