Neonatal Epignathus with hypoplastic left heart syndrome: Anaesthetic challenges and peri-operative implications

Abstract

Epignathus is the rare congenital oro-pharyngeal teratoma which can be associated with respiratory or digestive tract obstruction. We are describing a case of 10 days old neonate with epignathus and hypoplastic left heart syndrome, with complains of feeding difficulty and failure to thrive. She was posted for surgical excision under general anesthesia. The major anaesthetic challenges were maintaining intra-operative hemodynamic stability and securing the airway. We used sevoflurane for inhalational induction while maintaining the spontaneous ventilation and intubation was done nasally with gentle direct laryngoscopy, while an assistant was suspending the mass away from airway throughout the airway manipulation. The patency of patent ductus arteriosus was ensured with prostaglandin E1 infusion. Too our knowledge, this is the first case report of anaesthesic management of neonatal epignathus with hypoplastic left heart syndrome. A good patient outcome can be expected with strict adherence to planning, proper technique and utilizing expert's help as early as possible. © 2023 Elsevier Ltd