P088: THE AFTERMATH OF ZIKA: A CASE REPORT OF AN INFANT WITH CONGENITAL ZIKA SYNDROME
Catalina Coppola, MD; Christina C Moore, MD; Alecia Sabartinelli Stein, MD; Department of Pediatric Anesthesiology, University of Miami, Holtz Children's Hospital, Miami,FL
Introduction: Congenital Zika Syndrome (CZS) encompasses a constellation of fetal anomalies resulting from intrauterine Zika infection, including cranial and ocular malformations, brain anomalies, contractures, and neurologic sequelae.
The recent epidemic in 2015 resulted in widespread transmission of the Zika virus in the Americas. Zika spread to over 50 countries, including the United States. This led to an emerging population of pediatric patients with CZS presenting to operating rooms with no specific anesthetic guidelines available in the literature.
We discuss the anesthetic considerations of the first known case of cochlear device implantation in a child with CZS in the United States.
Case Presentation: A 2-year-old female presented for a scheduled right cochlear implant. She was a known case of CZS from the Dominican Republic whose mother was infected with the Zika virus while she was pregnant. The patient was born full-term at 38 weeks gestation via cesarean delivery for breech position. She presented with various congenital abnormalities including bilateral sensorineural hearing loss, bilateral cochlear hypoplasia, microcephaly, right microphthalmia, moderate tricuspid regurgitation, patent foramen ovale (PFO), motor weakness, and cognitive disabilities. Laboratory workup was unremarkable. EKG revealed normal sinus rhythm. Echocardiogram was significant for moderate tricuspid regurgitation and PFO with left to right shunting. Physical exam revealed a dysmorphic child with microcephaly and a right prosthetic eye in place. She had a holosystolic murmur. She was classified as ASA III risk assessment. The plan was right cochlear implant under general anesthesia with a multimodal approach for analgesia.
Prior to the procedure, standard monitors (EKG, NIBP, pulse oximeter, and temperature probe) were placed on the patient. She underwent an inhalation induction with Sevoflurane and airway was maintained via mask while IV access was placed. Propofol (3mg/kg) and glycopyrrolate (10mcg/kg) were administered prior to direct laryngoscopy. Successful oral endotracheal intubation was obtained on one attempt via direct laryngoscopy with a Miller 1 blade. General anesthesia was maintained with inhaled Sevoflurane. She was administered dexmedetomidine (0.5 mcg/kg bolus, followed by 0.3 mcg/kg/hr infusion), IV acetaminophen (0.15 mg/kg), and IV ketorolac (0.5 mg/kg) for multimodal anesthesia. She was extubated post-operatively in the OR and was monitored in the PACU for a safe discharge home 6 hours later.
Discussion: There are currently no anesthetic guidelines for infants with CZS outlined in the literature and a minimal number of case reports discussing the anesthetic care of a child with CZS. The goal is to understand and manage the diagnosed and potentially undiagnosed anomalies these patients may have. Additionally, appropriate screening of babies born to mothers with either known Zika infection or possible exposure to the virus would aid in appropriately preparing to care for these infants.
Conclusion: The 2015 epidemic resulted in an emerging number of infants with CZS who may require surgery in the future, thus posing a challenge to the unexpecting anesthesiologist. With limited data regarding anesthetic practice and perioperative morbidity, we summarize a case to add to the literature during which general anesthesia was successfully and safely performed on a patient with CZS.