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Anesth Analg 2004;98:334-335
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000096187.58714.B6

PEDIATRIC ANESTHESIA

Severe Hypotension in the Prone Position in a Child with Neurofibromatosis, Scoliosis and Pectus Excavatum Presenting for Posterior Spinal Fusion

Daniela Alexianu, MD, Eric T. Skolnick, MD, Annie C. Pinto, MD, Susumu Ohkawa, MD, David P. Roye, Jr., MD, David E. Solowiejczyk, MD, Joshua E. Hyman, MD, and Lena S. Sun, MD

From the Departments of Anesthesiology, Pediatrics, Orthopaedic Surgery and Division of Pediatric Cardiology, Columbia University College of Physicians & Surgeons and The Children’s Hospital of the New York-Presbyterian, New York, New York

Address correspondence and reprint requests to: Eric T. Skolnick, MD, Division of Pediatric Anesthesia, Children’s Hospital of NY-Presbyterian, 440N, 622 West 168th Street, New York, NY 10032. Address email to ets1{at}columbia.edu

A 34-mo-old boy with neurofibromatosis, scoliosis, and pectus excavatum developed severe hypotension when positioned prone. A magnetic resonance image study revealed neurofibromas encircling the great vessels. During the next anesthetic the patient was placed in the prone position on transverse bolsters and hypotension ensued again. A transesophageal echocardiogram (TEE) revealed compression of the right ventricle by the sternum. When the child was turned supine, the blood pressure returned to baseline. The patient was returned to the prone position, this time with bolsters placed longitudinally, without problem. This case supports a cardiac evaluation, possible intraoperative TEE, and avoidance of sternal pressure in patients with chest wall deformities requiring prone positioning.

IMPLICATIONS: A child with neurofibromatosis, scoliosis, and a chest wall deformity presenting for spinal fusion developed severe hypotension while prone. This was due to compression of the heart by the sternum, not compression of the great vessels by neurofibromas. Sternal pressure in prone patients with chest wall deformities should be avoided. Unique management included the use of transesophageal echocardiography to determine the cause of the hypotension.




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H. Edgcombe, K. Carter, and S. Yarrow
Anaesthesia in the prone position
Br. J. Anaesth., February 1, 2008; 100(2): 165 - 183.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.