Sevoflurane Sedation for High-Risk Airway Management in the Pediatric Intensive Care Unit Following Sclerotherapy for a Pediatric Cervical Lymphatic Malformation: A Case Report

Cervical lymphatic malformations (CLMs) can cause critical airway compromise due to post-sclerotherapy swelling, requiring precise sedation management in the pediatric intensive care unit (PICU). Precise airway management is especially challenging during the postoperative edema peak, where accidental extubation must be avoided. Inhalational sevoflurane provides rapid titration and predictable emergence, potentially allowing smoother management compared with traditional intravenous sedatives. We report the case of a one-year-old female patient (11.5 kg) with a massive CLM extending into the mediastinum who underwent bleomycin sclerotherapy. After the first procedure, intravenous sedation alone was insufficient, leading to agitation and unstable hemodynamics requiring vasopressor support. During the second procedure, similar agitation occurred despite initial intravenous sedation. Sevoflurane inhalational sedation via the Sedaconda® system was introduced 20 hours after PICU admission to achieve a stable and controllable sedation depth. This approach stabilized the patient, maintaining a State Behavioral Scale (SBS) of -1 to -2 at an end-tidal sevoflurane (EtSevo) concentration of 0.4-0.6%. It significantly reduced the requirement for intravenous agents and enabled smooth, predictable extubation without complications. Sevoflurane inhalational sedation may be a valuable alternative for sedation in pediatric patients at high risk for airway complications.