Hypoxia due to positive pressure ventilation in Edwards’ syndrome: A case report

Edwards’ syndrome also known as trisomy 18 is a congenital disorder associated with cardiovascular issues including ventricular septal defect (VSD), atrial septal defect (ASD) and patent duct arteriosus (PDA). An emergency colostomy was performed on a neonate born with an imperforate anus. Pre-operative transthoracic echocardiography showed presence of VSD, a patent foramen ovale (PFO) or ASD. Even though the baby had a good general condition and optimal peripheral oxygen saturation (SpO(2)), during positive pressure ventilation, she suffered severe hypoxia (50% SpO(2)). The cause of the hypoxia was thought to be the right-left shunt and so during a second attempt at anaesthesia a vasopressor (noradrenaline 0.03 µg/kg/min) was infused to increase systemic vascular resistance. Thereafter, SpO(2) increased to 80–90% and the surgery was completed. The baby recovered without any neurological complications. Genetic testing post-partum showed she had Edwards’ syndrome.