An Unusual Case of Sudden Collapse in the Immediate Postoperative Period in a Young Healthy Female with Myxofibroma of the Maxilla

Benign myxofibromas of heart are well known to cause systemic inflammatory mediator release causing multiple complications ranging from fever and widespread effusions to DIC and shock. We report that in a particular case of maxillary myxofibroma, a shock-like state and widespread serous cavities effusion presented in the immediate postoperative period. The occurrence was possibly due to release of inflammatory mediators by the tumour, disseminated during tumour resection causing diffuse capillary leak, precipitated by fluid resuscitation, leading to decrease in plasma oncotic pressure. 1. Introduction Odontogenic fibromyxoma is a rare benign tumour arising from odontogenic mesenchyme [1]. Shared field for airway and surgical access [2] is the main anaesthetic challenge along with a smooth postoperative course necessary for maintaining a patent airway as well as the suture line. Any systemic complications related to inflammatory mediator release by the tumour have not been reported before as the available data suggests. The written informed consent for publication of data was taken postoperatively from the patient and her parents when her condition stabilized on postoperative day two. 2. Case Report A 13-year-old otherwise healthy female was scheduled to be operated on for myxofibroma of maxilla by a combined team of neurosurgeons and dental surgeons. On routine preanaesthetic check-up, the patient was perceived to be a healthy, 40？kg female, not yet having attained menarche. The patient was receiving dexamethasone 4？mg 12-hourly preoperatively. Routine preoperative biochemical and radiological investigations comprising complete blood count (CBC), LFTs (liver function tests), KFTs (kidney function tests), CXR (chest X-ray), ECG, and PT/INR were within normal limits. After application of routine monitors, anaesthesia was induced with fentanyl 2？mcg/kg, midazolam 2？mg, and propofol 80？mg. Nasal intubation was facilitated by rocuronium 35？mg and McGill’s forceps. Maintenance of anaesthesia was done with inhalational isoflurane and oxygen nitrous mixture with supplementation of relaxant guided by half-hourly TOF count which was kept below two. Hemimaxillectomy using a Weber Fergusson incision with tumour excision was done. Patient was reversed and extubated after a sustained head lift of 5 seconds, and a TOF ratio of 0.9 was demonstrated. Patient was shifted to the neurosurgical ICU in the immediate postoperative period for overnight monitoring of vitals. Blood gases immediately after shifting and 1？hr thereafter were within normal limits. Pantoprazole