Anesthetic management for coarctation of aorta repair in a very low birth weight preterm infant: a case report

Abstract

Anesthetic management for cardiac surgery in very low birth weight (VLBW) preterm infants is highly challenging due to organ immaturity and metabolic vulnerability. Coarctation of the aorta (CoA) requiring early intervention adds further complexity. Reports on anesthesia for CoA repair in VLBW infants remain limited. A male infant born at 32⁺² weeks gestation with a VLBW of 1360 g underwent CoA repair at 39 days of age (weight 2600 g). Anesthesia was induced with etomidate (0.3 mg/kg) and maintained with sufentanil (2.5 µg/kg/h), propofol (6 mg/kg/h), and low-dose sevoflurane (0.5%). Mechanical ventilation was initiated with a tidal volume of approximately 9.6 mL/kg. Dopamine (5 µg/kg/min) was infused for hemodynamic support. Intraoperative blood glucose was monitored at induction (4.6 mmol/L), 1 h after incision (9.8 mmol/L), and at the end of surgery (significant transient intraoperative hyperglycemia of 15.6 mmol/L). Upon detection of hyperglycemia, which was likely multifactorial and potentially related to exogenous glucose administration, surgical stress, and dopamine infusion, although definitive causality cannot be established due to the absence of endocrine or metabolic assessments, glucose-containing infusions were immediately reduced. Blood glucose normalized spontaneously within 12 h without insulin therapy. The infant remained hemodynamically stable with no seizures, hyperosmolality, or neurological complications. He was extubated on postoperative day 3, discharged on day 26, and showed good catch-up growth at one-month follow-up. This case highlights the importance of individualized anesthetic regimens and routine, serial perioperative glucose monitoring in VLBW infants undergoing cardiac surgery. Even modest glucose infusion rates may lead to significant hyperglycemia under surgical stress, emphasizing the need for proactive glucose stewardship.