Anesthetic Management for Laparotomy of Necrotizing Enterocolitis in a Preterm Infant with Tetralogy of Fallot and Patent Ductus Arteriosus: A Case Report

Abstract

Anesthetic management of preterm infants with Tetralogy of Fallot (TOF) and patent ductus arteriosus (PDA), complicated by necrotizing enterocolitis (NEC), poses significant challenges. This case report describes a 1540-g male infant, born at 34 weeks and 4 days of gestation, diagnosed with TOF and PDA. Lipo-prostaglandin E1 (lipo-PGE1) was administered immediately to maintain PDA patency. At 18 days old, the infant developed lethargy, sepsis, and NEC stage IIIB, requiring an emergency exploratory laparotomy. Anesthetic management involved maintaining heart rate, contractility and preload, avoiding increases in the pulmonary vascular resistance (PVR) to the systemic vascular resistance (SVR) ratio, preventing PDA closure, and promptly addressing hypercyanotic spells. Surgical findings included extensive intestinal necrosis, necessitating multiple resections and the creation of an ileostomy and a jejunostomy. Postoperative care included meticulous cardiovascular and respiratory support, careful use of vasopressors, and precise lipo-PGE1 adjustments. The case highlights the need to maintain PDA patency in TOF, perform early surgical intervention for NEC, and provide precise postoperative care. The successful outcome was due to timely diagnosis, effective anesthetic care and surgery, and careful management, underscoring the importance of a coordinated, multidisciplinary approach.