A 2-day-old male baby with
patent ductus arteriosus and
pulmonary atresia had an emergency anoplasty because of
anal atresia. During the operation,
anesthesia was maintained satisfactorily with 1-2%
halothane and 70%
nitrous oxide in
oxygen, accompanied with continuous infusion of
prostaglandin E1 (
PGE1). However, after the inspired
oxygen concentration was changed to 100% from 30% at the end of the operation, transcutaneous partial pressure of
oxygen (PtcO2) began to decrease progressively, developing
cyanosis and sinus
bradycardia. Immediately the inspiratory concentration of
oxygen was returned to 30% from 100% and the infusion rate of
PGE1 was increased from 2 micrograms. kg-1.min-1.
Atropine 0.2mg was also administered intravenously. A few minutes after this
therapy, a gradual increase in PtcO2 was observed, and he recovered from
cyanosis and respiratory arrest. In this case, we suspect that the
cyanosis developed because of the contraction of PDA. In summary,
anesthetic management of a patient with
pulmonary atresia and PDA is described. The PtcO2 should be monitored continuously and the inspiration of pure
oxygen should be avoided. Continuous infusion of
PGE1 may be one of the effective measures to dilate PDA.