Cardiopulmonary and Airway Management in Pediatric Fraser Syndrome with Atrial Septal Defect During Laparoscopic Orchidopexy: An Observational Analytic Study of Shunt Dynamics

Abstract

Background. Fraser syndrome, uncorrected congenital heart disease, malnutrition, and laparoscopic surgery create overlapping airway and cardiovascular challenges in pediatric anesthesia.

Objective. To describe cardiopulmonary trajectories and airway management during laparoscopic orchidopexy in a child with Fraser syndrome and an atrial septal defect.

Methods. A single-patient observational case study involved a 10-year-old boy weighing 8.3 kg and measuring 80 cm, with Fraser syndrome, bilateral anophthalmia, intellectual disability, congenital cytomegalovirus history, and an ostium secundum atrial septal defect with right heart dilatation. The source states ethics approval (CMHC/EC/IRB/2026/4182) and parental consent. Management included midazolam, sevoflurane, fentanyl, cuffed intubation, atracurium, pneumoperitoneum at 6–8 mmHg, and normocapnic ventilation.

Results. A 4.5-mm cuffed tube was inserted on the first attempt. During the 120-minute procedure, mean arterial pressure ranged from 74.0 to 88.7 mmHg, heart rate from 82 to 95 beats/min, and oxygen saturation from 98% to 99%. Rate-pressure product remained below 12,500 bpm·mmHg, and net fluid balance was +10 mL. The source reports a Naranjo score of +9 and WHO-UMC classification of certain. Extubation occurred in the operating room without reported airway edema, desaturation, or hemodynamic collapse.

Conclusion. The reported course illustrates individualized airway preparation, ventilation, low-pressure pneumoperitoneum, and pharmacological management in a high-risk pediatric case. The causal interpretation of the reported findings requires author clarification.