Purpose or Case Report: Lymphatic malformations are congenital vascular anomalies caused by abnormal formation of lymphatic channels. These can be characterized as microcystic, macrocystic or mixed with an incidence of approximately 1 in 6000. These lesions are often asymptomatic, however may present with pain, swelling, recurrent infections or complications due to mass effect. Sclerotherapy is often first line treatment for many of these lesions as they are prone to recurrence after surgery if not completely resected. Sclerotherapy can be painful and require multiple treatments. Pain can preclude prolonged dwell of sclerosants during sclerotherapy. In this poster we describe our case series of sclerotherapy protocol with prolonged sclerosant dwell, 4 hours, formulated with our pediatric anesthesia team. Patients with macrocystic lymphatic malformations of the axilla, abdomen, and chest wall who underwent multi-session sclerotherapy with our new sedation protocol were reviewed. Four patients met the inclusion criteria for our case series. Patient ages ranged from 3-16. The initial procedures were performed with general anesthesia with placement of a locking pigtail drain ranging in size from 6.3 to 8.5 French. Sclerosants used included Sotradecol, bleomycin, with doxycycline left for prolonged dwell. The patients were subsequently extubated however monitored on a dexmedetomidine drip in the PACU. After 4 hours the doxycycline was aspirated and drains attached to bulb suction. Repeat procedures were performed every other day using dexmedetomidine and repeat 4 hours dwell for up to three procedures if needed. Others sclerosants were used during sclerotherapy however did not undergo prolonged dwell and were aspirated prior to the dwell. No sclerosant dwell was terminated early due to pain or complication. All patients tolerated the sedation and procedure well without complication. Three of the four patients underwent a subsequent multi-session sclerotherapy. All four patients had excellent response to therapy. This case series will review the details of the protocol and specifics of the cases.
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