A 3-yr-old girl was scheduled to undergo surgical repair of
tetralogy of Fallot. She had no sign or data indicating an
infectious disease, other than a slight dry
cough for a few days prior to the proposed operation. During the induction of
anesthesia with
nitrous oxide,
oxygen and
sevoflurane, transient moist
rale was noticed with a precordial
stethoscope. Her trachea was intubated without any difficulty after the administration of
pancuronium, followed by a chest auscultation, which revealed vesicular sound bilaterally but no
rale. However, a chest X-ray taken after the right subclavian vein catheterization showed a massive hypoaeration in the upper left pulmonary region. The presence of the right-to-left intracardiac shunt made it impossible to detect the occurrence of
atelectasis by a decrease in SpO2. Fiberoptic bronchoscopy showed no obstruction of the bronchus and no hypersecretion initially, but
physical therapy and humidification made it possible to aspirate intratracheal sputum. Because there seemed to be an imbalance between the relatively uneventful induction of
anesthesia and the relative resistance of
atelectasis to authentic
therapies, the operation was postponed, and the antibody to mycoplasma pneumoniae was titrated. The titer in the serum was 1:80, and increased to 1:560 6 days later. Chest X-rays revealed normal lung condition 3 days later, and she was given
erythromycin, 800 mg.day-1 for 2 weeks. We conclude that we should be alert to possible asymptomatic
mycoplasma infection, which potentially makes patients susceptible to
atelectasis during the
perioperative period.