TYK235
A 15 year-old child with a history of low thoracic level myelomeningocele presents to the ED with signs of a VP shunt obstruction and is scheduled for surgical revision. After induction, a urinary catheter is placed and the patient is prepped and draped for surgery in a sterile fashion. The anesthesiologist notes a profound decrease in blood pressure and marked increase in peak ventilatory pressures. What is the most likely cause of this change in condition?
a) Overdose of anesthesia
b) Anaphylaxis
c) Mucus plug in the endotracheal tube
d) Aspiration pneumonitis
e) Autonomic hyperreflexia
Answer
Answer b. Latex sensitivity is common in these patients, and under anesthesia hypotension may be the first sign of an anaphylactic reaction. A high level of suspicion is always warranted. However, the conscientious anesthesiologist should evaluate and treat for all of the above simultaneously. Overdose of anesthesia is always possible, as the patient will likely not have sensation below the umbilicus. A mucous plug or aspiration event may have occurred (particularly in the setting of vomiting due to VP shunt malfunction) and the ETT should be suctioned. Autonomic hyperreflexia is more common in patients with high thoracic spinal cord injury but may occur in those with low thoracic injury; it is a life-threatening emergency characterized by extreme hypertension following stimulation below the level of the injury. It is unlikely in this hypotensive patient.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.