Fatality in the perioperative period: A case report on refractory hypoxemia in an infant following open inguinal herniotomy.

INTRODUCTION AND IMPORTANCE OF THE CASE: Post-operative adverse respiratory events are not uncommon among infants.

PRESENTATION OF CASE: A 2-month-old male infant with an acyanotic heart disease underwent an elective open inguinal herniotomy under general anaesthesia. The intraoperative period was uneventful. The infant developed intermittent respiratory apnea and low oxygen saturation, followed by bradycardia in the post-anaesthesia care unit. Despite continued resuscitative efforts, the baby succumbed. The autopsy did not reveal new pathology. A period of interrupted monitoring during the recovery was noted. This could have led to undetected apnoea following an obstructed airway and resultant prolonged hypoxemia, further complicated by underlying structural heart disease.

CLINICAL DISCUSSION: Hypoxemia in the postoperative period in infants could be multifactorial. Airway obstruction due to secretions, airway spasms, and apnoea are common causes.

CONCLUSION

Prolonged hypoxia among paediatric patients could rapidly progress to cardiovascular collapse, hypoxic brain injury, and even death. This warrants close monitoring and active management during impaired oxygenation and ventilation during perioperative LMA use.