J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

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Case Report

Volume 10, Number 3, March 2019, pages 84-88

Anesthetic Implications of Malarial Infection in a Child

**Table 1.** Previous Reports of Anesthetic Care in Malaria
Authors and reference	Cohort demographics	Summary of anesthetic care and outcome
RSI: rapid sequence induction; PEEP: positive end expiratory pressure; ICU: intensive care unit.
Fareed and Mahmoud [17]	A 29-year-old male patient presenting with hepato-splenomegaly and splenic rupture with hemoperitoneum requiring emergency laparotomy.	Emergency laparotomy for splenectomy was successively performed after four units of whole blood transfusion. Histopathology of the specimen showed malarial pigments in macrophages and congested red pulp, confirming diagnosis of a malarial spleen. Antimalarial drugs were administered postoperatively.
Mathew et al [31]	A 26-year-old woman, presenting at 28 weeks gestation for emergency cesarean section for severe sepsis. A preliminary diagnosis of malaria was made and confirmed postoperatively.	RSI with thiopental and succinylcholine. Maintenance anesthesia with isoflurane in 50% nitrous oxide. PEEP of 5 cm H₂O was required to maintain oxygenation. A 1,140-g infant was delivered and required ventilator support. Intraoperatively, empiric antibiotics were administered along with the transfusion of two units of red blood cells. Postoperatively, the diagnosis of malaria was confirmed.
Zanfini et al [32]	A 27-year-old woman, with known P. falciparum infection, presenting at 28 weeks of gestation.	Emergent cesarean section under spinal anesthesia with bupivacaine and sufentanil. A 1.77-kg infant was delivered with respiratory distress, requiring oxygen support. The postoperative course of the mother was uneventful.
Pandey et al [33]	A 27-year-old woman, presenting at 29 weeks gestation, with malarial infection complicated by acute respiratory distress syndrome.	Emergency cesarean section after RSI with thiopentone and succinylcholine. A 1,181-g infant was delivered. Postoperatively, the mother was transferred to the ICU, where she required sedation with midazolam and morphine, intermittent neuromuscular blockade, and inotropic support with norepinephrine. She was successively weaned from mechanical ventilation after 10 days.
Yagmur et al [34]	Two patients (56 and 32 years of age) with splenic rupture, both being treated for malaria at the time of presentation.	Exploratory laparotomy with splenectomy performed in both cases with free blood in the peritoneal cavity and an enlarged ruptured spleen. The postoperative courses were uneventful.

Table 1. Previous Reports of Anesthetic Care in Malaria

Authors and reference

Cohort demographics

Summary of anesthetic care and outcome

RSI: rapid sequence induction; PEEP: positive end expiratory pressure; ICU: intensive care unit.

Fareed and Mahmoud [17]

A 29-year-old male patient presenting with hepato-splenomegaly and splenic rupture with hemoperitoneum requiring emergency laparotomy.

Emergency laparotomy for splenectomy was successively performed after four units of whole blood transfusion. Histopathology of the specimen showed malarial pigments in macrophages and congested red pulp, confirming diagnosis of a malarial spleen. Antimalarial drugs were administered postoperatively.

Mathew et al [31]

A 26-year-old woman, presenting at 28 weeks gestation for emergency cesarean section for severe sepsis. A preliminary diagnosis of malaria was made and confirmed postoperatively.

RSI with thiopental and succinylcholine. Maintenance anesthesia with isoflurane in 50% nitrous oxide. PEEP of 5 cm H₂O was required to maintain oxygenation. A 1,140-g infant was delivered and required ventilator support. Intraoperatively, empiric antibiotics were administered along with the transfusion of two units of red blood cells. Postoperatively, the diagnosis of malaria was confirmed.

Zanfini et al [32]

A 27-year-old woman, with known P. falciparum infection, presenting at 28 weeks of gestation.

Emergent cesarean section under spinal anesthesia with bupivacaine and sufentanil. A 1.77-kg infant was delivered with respiratory distress, requiring oxygen support. The postoperative course of the mother was uneventful.

Pandey et al [33]

A 27-year-old woman, presenting at 29 weeks gestation, with malarial infection complicated by acute respiratory distress syndrome.

Emergency cesarean section after RSI with thiopentone and succinylcholine. A 1,181-g infant was delivered. Postoperatively, the mother was transferred to the ICU, where she required sedation with midazolam and morphine, intermittent neuromuscular blockade, and inotropic support with norepinephrine. She was successively weaned from mechanical ventilation after 10 days.

Yagmur et al [34]

Two patients (56 and 32 years of age) with splenic rupture, both being treated for malaria at the time of presentation.

Exploratory laparotomy with splenectomy performed in both cases with free blood in the peritoneal cavity and an enlarged ruptured spleen. The postoperative courses were uneventful.