Anesthetic Management of a Case of Pediatric Rhabdomyosarcoma

Rhabdomyosarcoma, a tumor of skeletal muscle origin is the second most common soft tissue sarcoma seen in childhood after osteosarcoma. Common sites of occurrence are the genitourinary tract, retro peritoneum, head and neck and to a lesser extend, the extremities. RMS is a high-grade malignant tumor with extensive local invasion as well as early hemorrhagic and lymphatic dissemination. In spite of aggressive approaches including surgery, dose intensive combination chemotherapy and radiation therapy, patient with metastatic disease will usually have a poor outcome. Here we describe the management of a 13 year old child with RMS of fallopian tube requiring extensive staging laparotomy. Due to the extensive surgical resection intraoperative massive blood transfusion was required. Hemorrhagic shock in pediatric surgery is challenging to the anesthesiologist as well as surgeons. Current guidelines in managing major blood loss in adults involve initial resuscitation with crystalloid fluids followed by infusion of blood components as necessary. In contrast to adult population, the pediatric massive transfusion guidelines are vague and mostly it is managed almost in a similar fashion like an adult patient. Here, we attempt to identify challenges posed due to massive transfusion in pediatric age group.