ANESTHETIC MANAGEMENT OF BONE-MARROW TRANSPLANT RECIPIENTS LESS-THAN 2 YEARS OF AGE

The charts and anaesthetic records of 97 infants less than two years o f age who underwent bone marrow transplantation at the University of M innesota from 1978-1992 were retrospectively reviewed. These infants u nderwent 564 general anaesthetics. There were 48 perioperative complic ations, most (39) involving the airway. There were 20 difficult intuba tions occurring in 13 patients. The causes of the difficult intubation s were anatomical abnormalities (12), mucositis (4), pharyngeal oedema (3) and emesis upon induction of anaesthesia (1). Four intraoperative deaths occurred. The deaths were caused by haemorrhage (2), pulmonary embolism (1) and myocardial ischaemia (1). Four patients died within 72 h of surgery; one from cerebral oedema following an intraoperative cardiac arrest, one from fungal septicaemia, one from haemorrhage and one from multiple organ failure following an intracerebral haematoma. Infants undergoing bone marrow transplantation are at high risk for pe rioperative morbidity and mortality, particularly from complications i nvolving the airway, bleeding or sepsis.