Anesthetic management of pediatric patients with Kasabach-Merritt phenomenon undergoing radical resection for huge hemangioma of head and neck

Abstract

Nine pediatric patients (4 females, 5 males) with huge hemangioma of head and neck complicated with Kasabach-Merritt phenomenon, aged 15-135 days, undergoing elective radical resection for huge hemangioma of head and neck, were selected from June 2012 to June 2016 in our hospital.Two pediatric patients were sensitive to preoperative hormone treatment, the platelet count almost increased to the normal value, 7 pediatric patients were not sensitive to preoperative hormone treatment, and the increase in platelet count was not obvious.When the platelet count 100×109/L.Two pediatric patients with larger haemangioma in maxillofacial region kept spontaneous breathing, and anesthesia was induced by inhaling high-concentration of sevoflurane.Anesthesia was induced with intravenous midazolam, sufentanil and cisatracurium in the other seven pediatric patients.Pediatric patients were mechanically ventilated in pressure-controlled mode after endotracheal intubation with airway pressure of 9-12 cmH2O.All pediatric patients inhaled sevoflurane, and anesthesia was maintained by infusing remifentanil.Heart rate and systolic blood pressure were maintained within the normal range during operation.Fluid and blood products were infused according to the blood loss, urine volume, physiological requirement and central venous pressure, etc.Pediatric patients were transferred to pediatric intensive care unit (PICU) at the end of operation, and the endotracheal tube was removed after the patients were completely awake.One pediatric patient developed pulmonary infection after operation, was discharged from PICU on day 7 after operation, then cured and discharged from hospital after healing on day 20 after operation.The other eight pediatric patients were discharged from PICU on day 2 after operation, then cured and discharged from hospital on days 5-10 after operation.After a follow-up period of 1 yr, the pediatric patients recovered well, the platelet count was normal, and the tumor recurrence was not found. Key words: Hemangioma; Head and neck neoplasms; Anesthesia; Kasabach-Merritt syndrome