Hibino Tokimitsu, Okui Yusuke, Toba Yoshie
Department of Anaesthesiology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN.
Cureus. 2025 Feb 7;17(2):e78682. doi: 10.7759/cureus.78682. eCollection 2025 Feb.
Tonsillectomy is among the most common procedures performed on children. Children with congenital heart disease sometimes undergo tonsillectomy to reduce pulmonary arterial pressure. These children can have low cardiac function and low oxygen saturation (SpO) and pose particular challenges to the anesthesia team. In this article, we report our experience of anesthetic management of a child with post-Glenn procedure and Blalock-Taussig shunt dependence who underwent a tonsillectomy. To avoid postoperative hemorrhage, anti-coagulants/anti-platelets were discontinued five days before surgery. After discontinuation of these medications, we administered heparin until five hours before surgery. Anti-coagulants/anti-platelet medications were resumed on postoperative day 15 when epithelialization of the surgical wound was achieved. This strict management helped avoid hemorrhage but may have induced the subsequent postoperative Blalock-Taussig shunt embolic occlusion, which required reconstruction. In our case, we gave priority to the prevention of postoperative hemorrhage and delayed the restart of anticoagulation therapy, although we now believe that the risk of thrombosis should be given more attention and anticoagulation treatment should be restarted as soon as possible.
扁桃体切除术是儿童中最常见的手术之一。患有先天性心脏病的儿童有时会接受扁桃体切除术以降低肺动脉压。这些儿童可能心脏功能低下且血氧饱和度（SpO）低，给麻醉团队带来特殊挑战。在本文中，我们报告了一名接受格林分流术和依赖布莱洛克 - 陶西格分流术的儿童接受扁桃体切除术的麻醉管理经验。为避免术后出血，术前五天停用抗凝剂/抗血小板药物。停用这些药物后，我们在术前五小时前给予肝素。术后第15天，手术伤口上皮化完成后恢复使用抗凝剂/抗血小板药物。这种严格的管理有助于避免出血，但可能导致随后的术后布莱洛克 - 陶西格分流栓塞闭塞，这需要进行重建。在我们的病例中，我们优先预防术后出血并推迟抗凝治疗的重新开始，尽管我们现在认为应更关注血栓形成风险并应尽快重新开始抗凝治疗。
