Anesthetic Management in a Pediatric Patient with Cyanotic Congenital Heart Disease and Cerebral Abscess: A Case Report

Irwan Setiadi ¹, Muhammad Rezanda Alifahna ^1*, Radian Ahmad Halimi ¹, Dewi Yulianti Bisri ¹

This case report highlights tailored anesthetic strategies crucial for managing complex cardiac and neurological conditions in pediatric surgical patients.

Abstract

Brain abscesses, often linked to congenital heart disease, present a significant challenge in developing countries, where they constitute around 8% of intracranial mass cases. These abscesses lead to increased intracranial pressure and higher morbidity and mortality rates. Anesthetic management in patients with cyanotic congenital heart disease, such as those with ventricular septal defects (VSD) and pulmonary hypertension, is particularly complex due to the need to anticipate shunting at various stages. This case report details the anesthetic management of a 7-year-old boy with a suspected cerebral abscess, VSD, and pulmonary hypertension. The patient, presenting with intermittent headaches and cyanosis, underwent abscess drainage. Preoperative and intraoperative care focused on maintaining hemodynamic stability and preventing alterations in systemic and pulmonary vascular resistance. Sevoflurane was chosen for maintenance anesthesia due to its minimal impact on vascular resistance. Postoperative management included intensive monitoring and pain control to prevent complications such as hypoxia and cardiac decompensation. This case underscores the importance of tailored anesthetic strategies in managing patients with complex cardiac and neurological conditions undergoing surgery.

Keywords: Anesthetic management, Cyanotic congenital heart disease, Ventricular septal defect (VSD), Pulmonary hypertension, Cerebral abscess,.

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