[Anesthetic management of a low birth weight infant with giant sacrococcygeal teratoma].

We report the anesthetic management of a low birth weight infant (1912 g including the tumor) with a giant sacrococcygeal teratoma (Altman type II). The diagnosis was prenatally made at 24 weeks of gestation. She was delivered by emergent cesarean section at 28 weeks gestation, because fetal heart failure was aggravated by arteriovenous shunting through the tumor. Total resection was planned on day 0. Her trachea was intubated via nasotracheal route to prevent accidental extubation during surgery, which was performed in supine and prone position. A central venous line (5 Fr. double lumen) was inserted via right internal jugular vein for monitoring central venous pressure (CVP) and for rapid volume infusion. We infused volume to keep CVP at 10 mmHg throughout the surgery. The resected tumor weighed 766 g, total blood loss was 770 ml and blood transfusion was 965 ml. Although transient acidosis and hyperkalemia occurred, the surgery was completed and she was transferred to a neonatal intensive care unit in stable condition. In this case, nasotracheal intubation and the insertion of a central venous line were necessary and useful for the anesthetic management of the resection of giant sacrococcygeal teratoma.