• Kazuaki Tange, Miho Masaki, Ryoko Nakata, Rika Nogawa, Takaaki Negoro, and Kazuhiro Mizumoto.
• Department of Anesthesiology, Wakayama Medical University, Wakayamna 641-8510.
• Masui. 2014 Jan 1;63(1):94-7.

AbstractA 21-day-old female neonate weighing 3.2 kg was scheduled for surgical excision of a maxillary tumor under general anesthesia. The lesion was present since birth, with gradual enlargement since then. Preoperatively, the lesion measured 25 mm in diameter, although it was not known whether it was benign or malignant. The oral surgeon anticipated that the surgery would require 30 minutes for completion and would involve minimal bleeding. Hence, blood products were not prepared preoperatively. A good intravenous access was secured before induction of general anesthesia, which was achieved with IV thiopental. When it was ascertained that the patient could be easily ventilated by a bag and mask, rocuronium bromide was administered, together with inhalation of sevoflurane. However, the glottis could not be completely visualized on laryngoscopy for tracheal intubation with Cormack and Lehane scores of grade III. Hence, after discussion with the surgeon, we inserted a flexible laryngeal mask for airway management. During the surgery, unexpected massive hemorrhage occurred after incision of the tumor, followed by a severe drop in blood pressure. The amount of blood loss was 100 cc. For this catastrophic hypovolemia, we urgently transfused red cell concentrate (RCC). The surgical procedure lasted for 27 minutes and at the end of the surgery we successfully intubated the patient's trachea with a spiral tube using a guide wire and bronchofiber. After adequate blood transfusion to restore the patient's blood volume, a nasogastric tube was inserted and the patient was extubated in a fully awake state with establishment of adequate spontaneous breathing. Postoperatively, histopathologic examination revealed that the tumor was a jawbone medullary hemangioma.

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