[Perioperative management of pediatric patient with vena cava superior thrombosis complicated with nephrotic syndrome].

Nephrotic syndrome is a disease which accompanies hypoproteinemia, edema, hyperlipidemia and coagulopathy. This syndrome has also been recognized in pediatric patient. We experienced recently a case of 11-year-old girl, who had insertion of a plasma exchange catheter because of secondary hyperlipidemia due to nephrotic syndrome. She suffered soon from a severe SVC obstruction by thrombosis grown up around the catheter and an emergency thrombectomy was planned under the cardiopulmonary bypass. Renal function was maintained preoperatively, in comparison with nephrotic syndrome in adult where some problems in perioperative management, such as difficulties in tracheal intubation, choice of anesthetic drugs, blood and fluid management, monitoring without CVP and weaning from ventilator are observed. Induction was carried out carefully under spontaneous breathing and the anesthetic method we used consisted of balanced technique using N2O, O2, fentanyl and pancuronium bromide with moderate hyperventilation. Intraoperative course was uneventful and the patient was extubated on the second day after the operation without any neurological defects.