Perioperative anesthetic management of initial-stage surgery for cloacal exstrophy closure in an extremely low birth weight infant: a case report

Background Cloacal exstrophy (CE) is a rare and complex congenital anomaly. Perioperative anesthetic management is challenging when CE is accompanied by extreme prematurity and extremely low birth weight (ELBW). Case presentation A 670-g infant born at 25 weeks and 3 days of gestation underwent initial-stage surgery for CE on postnatal day 8. Opioid-based anesthesia with neuromuscular blockade was administered without hypnotic agents. A neonatal intensive care unit ventilator was transferred to the operating room to maintain ventilatory continuity. Invasive arterial pressure monitoring, active thermal control, and anticipation of circulatory compromise during abdominal wall closure were applied. Transient hypotension was treated with colloid administration, and the procedure was completed without major complications. No significant long-term complications occurred during the 4-year follow-up. Conclusions Perioperative stability in an extremely high-risk neonate with CE and ELBW was achieved by applying basic anesthetic principles, including ventilatory continuity, vigilant hemodynamic monitoring, and active thermal control.