Scimitar syndrome and anesthetic implications
We present a clinical case report of a child with scimitar syndrome and a review of the literature in order to describe the main surgical and anesthetic implications of these patients. Child, 4 months old, weight 4700 g, diagnosed with pneumonia and left lobar emphysema requires mechanical intubation and ICU care. The associated diagnoses are failed extubation, severe pulmonary hypertension and scimitar syndrome confirmed with echocardiography He was scheduled for pulmonary lobectomy. His mother signed an informed consent authorization for anesthesia and surgery. The child entered surgery, intravenous anesthetic induction was performed and a central venous catheter, an arterial line, urinary catheter and pre-and post-ductal pulse oximeters were inserted. He required vasopressor support with dopamine and transfusion of red blood cells. No adverse events during surgery. At the end of the surgery he was carried back to pediatric ICU and intubated with a chest tube. Extubation was successfully performed 2 days later with favorable progress. Scimitar syndrome is characterized by an anomalous right pulmonary venous return associated with congenital heart disease and pulmonary malformations. It has a low prevalence in the population but a very high perioperative morbidity and mortality, especially in children. With this report we present the main standards and practices for anesthetic management, monitoring and hemodynamic goals with these patients.
2. Wang CC, Wu ET, Chen SJ, Lu F, Huang SC, Wang JK, et al. Scimitar syndrome: incidence, treatment, and prognosis. Eur J Pediatr. 2008;167:155-60.
3. Vida VL, Padrini M, Boccuzzo G, Agnoletti G, Bondanza S, Butera G, et al. Historia natural y evolución clínica de los pacientes con sindrome de la cimitarra «no corregido». Rev Esp Cardiol. 2013;66:556-60.
4. Al Rukban H, Al Ghaihab M, Tamimi O, Al-Saleh S. Clinical spectrum of infantile scimitar syndrome: a tertiary center experience. Ann Pediatr Cardiol. 2014;7:29-33.
5. Vida VL, Padalino MA, Boccuzzo G, Tarja E, Berggren H, Carrel T, et al. Scimitar syndrome: a European Congenital Heart Surgeons Association (ECHSA) multicentric study. Circulation. 2010;122:1159-66.
6. Méndez E, Zamora J, Zeledón F, Induni E. Tratamiento quirúrgico innovador del drenaje venoso pulmonar anómalo parcial. Rev Costarric Cardiol. 2004;6:41-5.
7. Brizuela YS, Bechara JK, Jamaica L, Dies P, Motiño L. Síndrome de la cimitarra: un caso interesante. Bol Med Hosp Infant Mex. 2011;68:451-4.
8. Demir E, Askin M, Midyat L, Gülen F, Ulger Z, Tanac R, et al. Scimitar syndrome associated with partial anomalous pulmonary venous draining into superior vena cava. Eur J Pediatr. 2010;169:1263-5.
9. Gudjonsson U, Brown JW. Scimitar syndrome. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006:56-62.
10. Holt PD, Berdon WE, Marans Z, Griffiths S, Hsu D. Scimitar vein draining to the left atrium and a historical review of the scimitar syndrome. Pediatr Radiol. 2004;34:409-13.
11. Korkmaz AA, Yildiz CE, Onan B, Guden M, Cetin G, Babaoglu K. Scimitar syndrome: a complex form of anomalous pulmonary venous return. J Card Surg. 2011;26:529-34.
12. Karthekeyan RB, Yachendra, Kumar SM, Rao S, Vakamudi M, Komarakshi B, et al. Pneumonectomy in scimitar síndrome -is it correct? Ind J Thorac Cardiovasc Surg. 2008;24:176-9.
13. Kotecha MK, Krishnamanohar SR, Kumar RS. Scimitar syndrome with right hemianomalous pulmonary venous drainage into superior vena cava/right atrium junction. Congenit Heart Dis. 2012;7:62-5.
14. Golianu B, Hammer GB. Pediatric thoracic anesthesia. Curr Opin Anaesthesiol. 2005;18:5-11.
15. Friesen RH, Williams GD. Anesthetic management of children with pulmonary arterial hypertension. Paediatr Anaesth. 2008;18:208-16.
16. Abman SH. Pulmonary hypertension in children: a historical overview. Pediatr Crit Care Med. 2010;11:S4-9.
17. Carmosino MJ, Friesen RH, Doran A, Ivy DD. Perioperative complications in children with pulmonary hypertension undergoing noncardiac surgery or cardiac catheterization. Anesth Analg. 2007;104:521-7.
18. Shukla AC, Almodovar MC. Anesthesia considerations for children with pulmonary hypertension. Pediatr Crit Care Med. 2010;11:S70-3.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.