1 case report on the treatment of ectopic cytoblastoma anaesthetic in children

Child, male, 9 years old, 26kg"One week after discovery" was admitted to hospital on 8 October 2016Family description of the past history is not special; chest CT (Figure 1) shows: left rear isolation low density block shadow (6.8 cm x 4.5 cm); laboratory examination (-)When the child is in the room, he is irritable, sweating and cryingBlood pressure (BP) 270/130mmHg, heart rate (HR) 140bpmRepeatedly asked about the medical history, found that the child before June began to have more sweat, palpitations, pale, headache symptomsHighly suspected of anisoerophilid atomoma, suspended surgeryThe same day the results of the plasma norepinephrine 23231 ng/L, urine norepinephrine 2983 ?g/24h, dopamine 1807 ?g/24hDiagnosis: left rear vertical occupant position: chrome-clytic tumor?Figure 1 Child chest CTpreoperative preparation: oral catoplypley, prophyl, phenolic triple control blood pressure parallel expansion, regular treatment after 2 weeks, BP control in 100 to 130/ 70 to 100mm, HR90 to 100b, again scheduled surgeryAnesthetic management: preoperative soothing, children accompanied by family members, emotional stability, BP130/90mmHg, HR110bpmAnesthetic induction using midazolam 1mg, fentanyl acid 150?g, propofol 100 mgImmediately after the child falls asleep, the arterial puncture tube monitors the direct arterial pressureGive Viku bromine 2mg, Airol 20mg, 2% Lidoca in the sound door surface anesthesia after the trachea intubationRight-hand intra-cervical intravenous tube monitoring center venous pressure (CVP) anaesthetic maintains the use of heptafluoroethee, fentanyl acid and viku ammonium During disinfection, the patient's BP jumped to 190/130mmHg, HR130bpm, immediately gave Aislor 20mg, and continued pump phenoltolamine In the process of tumor separation, the pump speed and rehydration speed of the vascular active drug are adjusted according to BP, HR and CVP Tumors are free and phenoltolamine and Eslor are deactivated before clamping blood vessels Blood pressure quickly drops to 80/50mmHg after tumor removal, heart rate 130bpm, accelerated rehydration fluid, and continuously pumped norepinephrine at the initial dose of 0.5?g/kg-min, then gradually increased to 2 ?g/() kg-min), and need intermittent intravenous injection of norepinephrine, blood pressure gradually leveled off, surgery for 5 hours, bp95/60mmHg, HR110bpm, CVP14mmHg, tube into the ICU postoperative management: norepinephrine gradually reduced to 24h after surgery, circulation stability, removal of trachea catheter The pathological results showed that the later septum was a parastatal tumor 4 days after surgery plasma norepinephrine 321 ng/L The child was discharged from the hospital 5 days after the operation and there were no complications in follow-up for 30 days after the operation discussion
chromosomal tumor is a neuroendocrine tumor that secretes catecholamine, with a incidence rate of about 0.8 per 100,000, and ishemoth almost 15% to 25% of them, good pot, abdominal and chest Unidentified cytomoblastoma can have a perinatal mortality rate of up to 50% due to lack of adequate preoperative preparation There is no pediatric ectopic cytomoblastoma permeator period anesthesia management guidelines, such anesthesia can only be treated with experience, and because of its low incidence, most hospitals face this kind of anesthesia experience, the risk of perioperative period increased Therefore, it is only through the publication of case reports, the continuous accumulation of this kind of patient anesthesia experience summarize the main points of management period management of ectopic cyphematoma perinatal: (1) Children ectopic cytomamycinoma patients due to unclear expression, lack of coordination and other reasons, easy to lead to missed diagnosis, misdiagnosis For children with substantial lumps in the abdomen, basin or chest cavity, preoperative evaluation should pay attention to the absence of nonspecific symptoms such as headache, sweat, palpitations, highly suspect should be as soon as possible to allow specialists to intervene in the diagnosis and treatment; Pay attention to humane care, full communication and appeasement before surgery, children recommend to be accompanied by family members This case of the child re-entered the chamber mood and circulation is stable, reflecting the importance of perfecting preoperative preparation and psychological intervention; (3) anesthesia-based general anesthesia, should maintain sufficient anaesthetic depth, as soon as possible to establish a invasive arterial blood pressure and CVP monitoring to guide drug use and capacity treatment (4) Intraoperative detection and free tumor can cause severe fluctuations in hemodynamics in children, not timely treatment can appear hypertension risk, after removal of the tumor, due to the sudden decline in catecholamine content and residual pressure-lowering drugs, vascular dilation can cause low blood capacity shock anesthesiologists should be familiar with the pathophysiology and surgical process of the disease, identify the risk factors that lead to violent fluctuations in hemodynamics, and correctly deal with them in a timely manner This case of children have been fully prepared before surgery, timely adjustment of vascular active drugs, but there are still large fluctuations in hemodynamic time In addition, after the block removal to maintain the stability of vital signs, norepinephrine use of up to 10 to 50 sg / min, more than the expert consensus recommended 8 to 12 sg / min the reasons may include: (1) large tumor, preoperative secretion of catecholamine levels high; (4) Postoperative management: vascular active drug therapy can be extended to 24 to 48h after surgery, to help the heart muscle on catecholamine dependence withdrawal Heterophilidal cytomainoma may still cause complex changes after surgery, so it still needs to be closely observed after surgery in general, the risk of pediatric ectopic cytomoblastoma surgery anaesthetic is greater, it is necessary to improve the correct rate of diagnosis, standard preoperative treatment, fine perioperative period management, in order to improve the safety of the perinatal period of children, improve the prognosis