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Arun O, Oc B, Metin EN, Sert A, Yilmaz R, Oc M. Anesthetic management of a child with Cornelia de Lange Syndrome undergoing open heart surgery: A case report. World J Cardiol 2022; 14:54-63. [PMID: 35126872 PMCID: PMC8788174 DOI: 10.4330/wjc.v14.i1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/14/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cornelia de Lange syndrome (CdLS) is a congenital multisystemic genetic disorder. The expected lifespan of children with this disorder has been prolonged in parallel with the advances in medicine in recent years. However, they still more frequently undergo cardiac surgery. There are some challenges for clinicians when faced with CdLS patients. We present the perioperative management of a child with CdLS undergoing open-heart surgery.
CASE SUMMARY Severe pulmonic and subpulmonic valvular stenosis, enlargement of the right side of the heart, mild tricuspid regurgitation, atrial septal defect, and patent ductus arteriosus were diagnosed in a 14-month-old boy with manifested cyanosis, developmental delay, and malnutrition. Attempted balloon valvuloplasty was unsuccessful due to a severe stenotic pulmonary valve, therefore it was decided to perform an open surgical repair. Following a successful and uncomplicated intraoperative course, the patient was extubated on postoperative day 5, and adrenalin and dopamine infusions were gradually decreased and stopped on postoperative days 6 and 10, respectively. Moderate laryngomalacia and suboptimal vocal cord movements were diagnosed, and tracheotomy and percutaneous endoscopic gastrostomy were performed under general anesthesia in the same session at postoperative day 32. The patient was discharged on postoperative day 85 after a challenging postoperative period with additional airway and nutritional problems.
CONCLUSION This is the first report of the perioperative anesthetic and clinical management of a CdLS patient undergoing open-heart surgery.
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Affiliation(s)
- Oguzhan Arun
- Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya 42130, Turkey
| | - Bahar Oc
- Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya 42130, Turkey
| | - Esma Nur Metin
- Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya 42130, Turkey
| | - Ahmet Sert
- Department of Pediatric Cardiology, Selcuk University Faculty of Medicine, Konya 42130, Turkey
| | - Resul Yilmaz
- Pediatric Intensive Care, Selcuk University Faculty of Medicine, Konya 42130, Turkey
| | - Mehmet Oc
- Department of Cardiovascular Surgery, Selcuk University Faculty of Medicine, Konya 42130, Turkey
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Park SJ, Choi EK, Park S, Bae K, Lee D. Successful difficult airway management using GlideScope video laryngoscope in a child with Cornelia de Lange Syndrome. Yeungnam Univ J Med 2018; 35:219-221. [PMID: 31620597 PMCID: PMC6784706 DOI: 10.12701/yujm.2018.35.2.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 11/09/2022] Open
Abstract
Management of airway in a child with Cornelia de Lange Syndrome (CdLS) should be given due consideration because most of them have the problems related to difficult airway. The GlideScope video laryngoscope can be attempted during routine intubation, however it is mostly used in case of difficulty. With adequate preoperative airway assessment, we used the pediatric video laryngoscope as useful alternative airway device in a child with CdLS and orotracheal intubation proceeded uneventfully.
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Affiliation(s)
| | - Eun Kyung Choi
- Corresponding Author: Eun Kyung Choi, Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-3361, Fax: +82-53-626-5275 E-mail:
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Asahi Y, Tsujimoto I, Kawai Y, Sugimoto M, Suzuki T, Omichi S, Kogo M, Kotani J. General anaesthesia with and without intubation for patients with Cornelia de Lange syndrome. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2009.10872614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shin WJ, Kim SD, Kim KH. The general anesthesia experience of deletion 8p syndrome patient -A case report-. Korean J Anesthesiol 2011; 61:332-5. [PMID: 22110888 PMCID: PMC3219781 DOI: 10.4097/kjae.2011.61.4.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 02/21/2011] [Accepted: 03/11/2011] [Indexed: 11/10/2022] Open
Abstract
A deletion 8p syndrome is a relatively uncommon congenital disease characterized by mental retardation associated with multiple malformation that make anesthetic management a challenge. Anesthetic management of a patient with deletion 8p syndrome may pose a serious problem mainly from difficult tracheal intubation, aspiration complication and cardiac malformation. We experienced a case of 10 year-old boy with a deletion 8p syndrome who underwent appendectomy under the general anesthesia. Intubation was performed by video glidescope after unsuccessful attempt with Macintosh laryngoscope. A high arched palate, short neck, poor patient cooperation due to mental retardation and occasional autistic behaviour made airway management difficult. This case should alert anesthesiologists to the greater difficulties of managing patients with deletion 8p syndrome.
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Affiliation(s)
- Woo Jong Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Successful and safe delivery of anesthesia and perioperative care for children with complex special health care needs. J Clin Anesth 2009; 21:165-72. [PMID: 19464608 DOI: 10.1016/j.jclinane.2008.06.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 06/26/2008] [Accepted: 06/26/2008] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To determine the utilization of anesthesia resources by children with complex special health care needs. DESIGN Observational, inception cohort study of medical records. SETTING Urban, pediatric, tertiary-care hospital. MEASUREMENTS All general anesthetic cases were screened for preexisting complex special health care needs. Medical records were reviewed for demographic, clinical, and outcome data. MAIN RESULTS 435 children with complex special health care needs accounted for 479 delivered general anesthetic cases. This figure represented 14% of the total 3,437 cases presenting during the study period. It also represented 22% (49 of 224) of all cancellations. Down syndrome was the most identifiable developmental disorder (n = 43, 9%). Another 143 (30%) cases showed preexisting technology dependence. Scheduled surgical procedures (n = 425, 89%) comprised the majority of cases. Intraoperative and recovery room complications occurred in 6 (1%) and 133 (28%) cases, respectively. Eleven (2.3%) cases required unplanned post-anesthetic hospital ward or pediatric intensive care unit admission. Documentation of health care proxy or resuscitation status was not identified in any child under 18 years, and in only 4 of 33 children older than 18 years. CONCLUSIONS Children with complex special health care needs represented one out of 7 of all pediatric general anesthetic cases at a tertiary-care, academic center.
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Perdomo Perdomo MB, Martín Iglesias A, Rodríguez Germá I, Díaz Fuentes MA, Barrientos Fernández MG, Besada Estévez JC. [Air embolism during laparoscopic surgery in an infant girl with Cornelia de Lange syndrome]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:449-453. [PMID: 19856692 DOI: 10.1016/s0034-9356(09)70426-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Cornelia de Lange syndrome involves multiple malformations with particular phenotypic features (craniofacial abnormalities such as microcephaly or hypertrichosis with synophrys; cutaneous abnormalities such as hirsutism, and limb anomalies) and it is associated with a high percentage of mental retardation and complications such as digestive tract abnormalities, cardiac defects, and endocrine disorders. We report the case of a 2-month-old infant girl who underwent a laparoscopic antireflux procedure, with closure of a diaphragmatic hernia and a gastric stoma. The medical history included repeated episodes of aspiration pneumonia and hypertension. Early in the procedure, 2 episodes of sudden desaturation, hypotension, and bradycardia with a probable diagnosis of air embolism. The complications resolved with specific treatment. Anesthetic management for laparoscopic surgery in these patients is truly complex and must be informed by a thorough understanding of the disease and complications that may develop.
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Affiliation(s)
- M B Perdomo Perdomo
- Servicio de Anestesiología y Reanimación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife.
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Toker AS, Ay S, Yeler H, Sezgin I. Dental findings in Cornelia de Lange syndrome. Yonsei Med J 2009; 50:289-92. [PMID: 19430566 PMCID: PMC2678707 DOI: 10.3349/ymj.2009.50.2.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Revised: 04/23/2004] [Accepted: 04/23/2004] [Indexed: 11/27/2022] Open
Abstract
Cornelia de Lange syndrome is a congenital disease, basically characterized by psychomotor retardation associated with a series of malformations, including mainly skeletal, craniofacial deformities together with gastrointestinal and cardiac malformations. There is no definitive biochemical or chromosomal marker for the prenatal diagnosis of this syndrome. We actually want to present the case of a 10-year-old patient, who was admitted to our clinic for dental pain. The patient had the symptoms of Cornelia de Lange syndrome. During the oral examination of this patient, the patient was found to have the typical symptoms of Cornelia de Lange syndrome, such as micrognathia and delayed eruption in conjunction with the symptoms of the Hutchinson's syndrome, which had never been reported before.
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Affiliation(s)
- Aslihan Soyal Toker
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey
| | - Sinan Ay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Hasan Yeler
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey
| | - Ilhan Sezgin
- Department of Medical Biology and Genetics, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Cho SY, Jeon WJ, Cho YH, Shim JH, Yeom JH, Shin WJ, Kim KH. The general anesthesia experience of cornelia de lange syndrome patient - A case report -. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.6.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sang Yun Cho
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Seoul, Korea
| | - Woo Jae Jeon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Seoul, Korea
| | - Yung Hyun Cho
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Seoul, Korea
| | - Jae Hang Shim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Seoul, Korea
| | - Jong Hoon Yeom
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Seoul, Korea
| | - Woo Jong Shin
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Seoul, Korea
| | - Kyoung Hun Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Seoul, Korea
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Ro J, Kim EJ, Lee JH, Min BW, Lee SG, Ban JS. Anesthesiologic considerations in a pediatric patient with cornelia de lange syndrome - A case report -. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.5.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jiyung Ro
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Eun Ju Kim
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Ji Hyang Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Byung Woo Min
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Sang Gon Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jong Suk Ban
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
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Fernández-García R, Pérez Mencía T, Gutiérrez-Jodra A, López García A. Anesthetic management with laryngeal mask in a child with Brachmann-de Lange syndrome. Paediatr Anaesth 2006; 16:698-700. [PMID: 16719891 DOI: 10.1111/j.1460-9592.2005.01835.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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