Stevic Marija, Bokun Zlatko, Milojevic Irina, Budic Ivana, Jovanovic Branislav, Krstic Zoran, Simic Dusica
Department of Anesthesia, University Children's Hospital, Belgrade, Serbia.
Med Princ Pract. 2016;25(3):290-2. doi: 10.1159/000443017. Epub 2015 Dec 4.
The aim of this paper was to report the management of anesthesia of a child with a large neck rhabdoid tumor.
A 9-month- old female patient underwent urgent neck tumor excision due to intratumoral bleeding from a large tumor that compressed and dislocated the trachea; therefore, intubation was expected to be difficult. Sevoflurane inhalation induction was utilized to maintain spontaneous respiration. Oral laryngoscopy revealed Cormack-Lehane grade 3 laryngeal view. The trachea was intubated using a reinforced tube on the third attempt. Fiberoptic bronchoscope-assisted intubation was planned as an alternative in case of conventional intubation failure. Anticipation of massive blood loss necessitated central venous catheterization.
Establishing a safe airway, intubation during spontaneous breathing and invasive hemodynamic monitoring are crucial factors in the anesthetic management of pediatric patients with a large neck tumor.
本文旨在报告一名患有巨大颈部横纹肌肉瘤患儿的麻醉管理情况。
一名9个月大的女性患者因巨大肿瘤内出血导致肿瘤压迫并使气管移位，遂紧急进行颈部肿瘤切除术；因此，预计插管困难。采用七氟烷吸入诱导以维持自主呼吸。经口喉镜检查显示Cormack-Lehane 3级喉镜视野。第三次尝试时使用加强型气管导管成功插管。若传统插管失败，则计划采用纤维支气管镜辅助插管作为替代方案。鉴于预计会有大量失血，故有必要进行中心静脉置管。
建立安全气道、自主呼吸状态下插管以及有创血流动力学监测是颈部巨大肿瘤患儿麻醉管理中的关键因素。
