Anesthesia and surgical collaboration on an extremely low birth weight infant undergoing ligation of patent ductus arteriosus
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Patent ductus arteriosus (PDA) is one of the most common congenital cardiac anomalies in infants. Spontaneous closure of ductus arteriosus takes long time in preterm infants. Early ligation is advised in very low birth weight infants but surgical risk is bigger in older infants. In this presentation we report an anesthetic management in a male preterm infant weighing 600 grams, who underwent PDA ligation. He was born at gestation age of 24 weeks at another hospital, and since his birth he has been observed to have infant respiratory distress syndrome. Hemodynamic deterioration, ventilator dependency, increase in heart murmur, deterioration of the general status and irresponsivity to indomethacine was observed in the patient and the patient was referred to our center for surgical ligation of the PDA. He was transferred to our center in an incubator and with diagnosis of PDA. Bradycardia (50 beats/min) developed during echocardiography in our center and the patient was intubated and transported to the operating room. General anesthesia was induced by fentanyl 5µg, 0.4mg rocuronium and ketamine 0.15 mg intravenously. Anesthesia was maintained with 1.5-2.5 % sevoflurane in 50 % air and oxygen at an inspired concentration titrated to stabilize the vital signs. Because of the extreme low weight of the infant, invasive arterial monitorization and positioning was difficult. The PDA was ligated with titanium clips through left thoracotomy. The postoperative course was uneventful and he was discharged on the 77 th day,1750g of weight.