Caudal anesthesia for anoplasty in a toddler with uncorrected tetralogy of Fallot: a case report

Background: Non-cardiac surgery is prevalent among individuals with a history of cyanotic congenital heart disease (CHD), including tetralogy of Fallot (ToF). Surgical and anesthetic procedures in such patients may lead to multiple complications. In the selected patient group, neuraxial block, a specific type of caudal anesthesia, can be a viable alternative for anesthetic management. Objective: The study aimed to assess the efficacy of caudal anesthesia as postoperative analgesia for an infant with uncorrected ToF who underwent anoplasty. Methods: The case was a 17-month-old female toddler with uncorrected ToF who underwent anoplasty to treat anorectal malformation. For the anoplasty performance, the patient received caudal anesthesia with sedation using bupivacaine. In addition, sedation was carried out using low-dose ketamine and midazolam combination following fluid rehydration. The entire surgical procedure was performed in the prone position and lasted approximately 60 minutes. Results: Based on intraoperative monitoring records, patient exhibited stable hemodynamics with no intraoperative or postoperative complications. Intraoperative systolic blood pressure ranged from 70 to 80 mmHg, diastolic blood pressure from 35 to 40 mmHg, and heart rate from 120 to 140 beats per minute, respectively. Conclusion: This study showed that caudal analgesia is an effective analgesic technique associated with few adverse effects and positive outcomes in pediatric patients with ToF.