Congenital vascular abnormality often presents with complicated anatomy and physiology that may result in very challenging anesthesia management, particularly for a small child.1,2 Understanding the uniqueness of the anatomy and physiology is critical to optimize the care of the patient with unique vascular abnormality.3 Panels A and B show computed tomography and a three-dimensional reconstructed image of pulmonary sequestration and feeding vessels of 1-yr-old boy. However, it was still challenging to identify the take-off of the feeding vessels under direct vision in the surgical field, and the surgeon inadvertently and incorrectly ligated the feeding vessels. Due to the complexity of the case, the anesthesia care team placed an arterial line in the right radial artery to monitor upper extremity perfusion and placed a pulse oximeter on the left foot to monitor lower extremity perfusion and oxygenation. The surgeon successfully identified the two feeding vessels, which appeared to take off from a common vessel (panel C). However, ligating the assumed common feeding vessel led to the instantaneous elevation of arterial blood pressure measured in the radial artery and loss of pulse oximetry signal from the lower extremity. The anesthesia team promptly communicated with the surgeon that removing the ligation rendered the return of the pulse oximetry signal in the foot. Re-exploration allowed the surgeon to identify and ligate the take-off of the feeding vessel correctly. Carefully reviewing the images preoperatively and applying the monitors to reflect the uniqueness of the anatomy are paramount for surgery and anesthesia.
The authors declare no competing interests.