Surgical Resection of Neonatal Sacrococcygeal Teratoma: An Anaesthetic Challenge

Abstract

Sacrococcygeal teratomas (SCT) are known to originate from pluripotent cells and are among the most common perinatal germ cell tumours with an incidence of 1:30000- 1:40000. Primary treatment is surgical resection. Here we present a case of a term 3.38kg female baby delivered via normal vaginal delivery who presented with a large cystic lesion 10x15cm in size distal to the coccyx. The neonate was posted for surgery on day 2 of life. The procedure was done in lithotomy position and exceeded 4 hours duration. One episode of intra operative hypotension was noted for which IV dopamine infusion was started at 10mcg/kg/minute. Through-out the procedure the body temperature was maintained with body warmer and fluid warmers in place. Blood loss exceeded the maximum allowable blood loss of 100ml which was replaced by packed red blood cells administered at 15ml/kg to a total of 55ml. The baby was shifted to the NICU with endotracheal tube insitu for further management in the postoperative period. Hyperkalemia was noted and corrected in the NICU. The baby was extubated on post-operative day 3 and discharged on day 5 after surgery. Resection of large Sacrococcygeal teratomas can be challenging and requires meticulous planning, vigilance, and a multidisciplinary team approach.