Scimitar syndrome and anesthetic implications

Abstract

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.