Refractory Bradycardia and Unreactive Mydriasis Revealing Severe Intraoperative Neonatal Hypothermia in a Resource-Limited Setting

Perioperative hypothermia represents a major complication in pediatric anesthesia, particularly in neonates. We report the case of a newborn who underwent general anesthesia for esophageal fistula repair (following primary repair of esophageal atresia) and developed severe hypothermia manifested by the triad of refractory severe bradycardia, bilateral areflexic mydriasis, and chest wall rigidity. Management combining active rewarming, alkalinization, and cardiovascular support resulted in a complete recovery with a progressive normalization of clinical parameters. We discuss the clinical signs observed during this complication and draw the attention of anesthesiologists practicing in resource-limited settings, for whom these signs may enable early diagnosis of this complication.