Khan M, Hoda M Q.
Infantile Sacrococcygeal Teratoma - intraoperative Cardiac Arrest due to Electrolyte Imbalance.
J Pak Med Assoc Jan ;53(5):202-4.

Fifteen hours old, 2.7 Kg, full term, was presented in emergency, with a single huge mass approximately 14 x 15 centimeters extending on to both buttocks (Figures 1 and 2). Tumour was generally cystic in consistency but firm at places with breaching epithelium underlying hemorrhage and echymosis. Preoperative investigations showed Haemoglobin 16.0 gm/dl, Hematocrit (Hct) 47.6, Platelets 96 x 109/lit, prothrombin time 16.3 seconds (control 12 Seconds), activated partial thromboplastin time 62 seconds (control 30 Seconds) with INR 1.6, magnesium 1.5 meq.lit (1-2 meq.lit), Calcium, 8.2 mg/dl (10mg/dl) Phosphate 9.8+ mg.dl (4.4 - 6.6 mg.dl), Sodium 132 mmol.lit, potassium 4.8 mmol.lit and Lactic Dehyodrogenase (LDH) 2735 IU.lit (253 - 548 IU.lit). In next 12 hours patient dropped his Hemoglobin from 16 gm. dl to 12.3 gm.dl and Hct 37.0, which was replaced with packed cells and coagulation was corrected prior to surgery by Fresh Frozen Plasma (FFP). Surgery was performed 27 hours after delivery. Intraoperative monitoring included ECG, heart rate, noninvasive blood pressure, End-tidal CO2, Pulse oximetry , temperature, and oesophageal stethescope. Surgery lasted for about two hours in prone position. Intraoperative blood loss was approximately 135 ml. which was replaced by 120 ml of packed cells, 50 ml of FFP and 50 ml of crystalloid. Near the end of surgery, the patient developed prolonged Q-T interval on ECG followed by ventricular tachycardia. The situation was managed immediately by turning the neonate in supine position and external cardiac massage was started. During CPR, he received adrenaline, bolus of normal saline and calcium gluconate. Normal sinus rhythm with good cardiac output was reestablished within 5 minutes. In the immediate post resuscitation period, he developed seizures activity for which he received valium and was loaded with phenytoin sodium.

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