Pulmonary Hypertensive Crisis During General Anesthesia in a 3-Year-Old Autistic Boy With Undiagnosed Scurvy, Undergoing Cardiac Catheterization

Abstract Objectives: To describe the association between successful weaning of inhaled nitric oxide and trends in dead space ratio during such weans in patients empirically initiated on nitric oxide therapy out of concern of pulmonary hypertensive crisis. Patients: Children in a cardiac intensive care unit initiated on inhaled nitric oxide out of clinical concern for pulmonary hypertensive crisis retrospectively over 2 years. Measurements and Main Results: Twenty-seven patients were included, and nitric oxide was successfully discontinued in 23/27. These patients exhibited decreases in dead space ratio (0.18 versus 0.11, p = 0.047) during nitric oxide weaning, and with no changes in dead space ratio between pre- and post-nitric oxide initiation (p = 0.88) and discontinuation (p = 0.63) phases. These successful patients had a median age of 10 months [4.0, 57.0] and had a pre-existent diagnosis of CHD in 6/23 and pulmonary hypertension in 2/23. Those who failed nitric oxide discontinuation trended with a higher dead space ratio at presentation (0.24 versus 0.10), were more likely to carry a prior diagnosis of pulmonary hypertension (50% versus 8.7%), and had longer mechanical ventilation days (5 versus 12). Conclusions: Patients empirically placed on nitric oxide out of concern of pulmonary hypertensive crisis and successfully weaned off showed unchanged or decreased dead space ratio throughout the initiation to discontinuation phases of nitric oxide therapy. Trends in dead space ratio may aid in determining true need for nitric oxide and facilitate effective weaning. Further studies are needed to directly compare trends between success and failure groups.

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Preventing pulmonary hypertensive crisis in the pediatric patient after cardiac surgery

American Journal of Critical Care ◽

10.4037/ajcc1995.4.1.49 ◽

1995 ◽

Vol 4 (1) ◽

pp. 49-53 ◽

Cited By ~ 1

Author(s):

L Medicus ◽

L Thompson

Keyword(s):

Cardiac Surgery ◽

Heart Defects ◽

Hypertensive Crisis ◽

Supplemental Oxygen ◽

Cardiac Surgery Patient ◽

Positive End Expiratory Pressure ◽

Care Nurse ◽

Surgery Patient ◽

Pulmonary Hypertensive Crisis ◽

Infants And Young Children

Pulmonary hypertension is seen in infants and young children who have congenital heart defects resulting in excess pulmonary blood flow. The critical care nurse can implement several interventions in the immediate postoperative period to help prevent the potentially lethal complication of pulmonary hypertensive crisis in a cardiac surgery patient. Respiratory interventions include hyperventilation, maintaining an alkalotic pH, supplemental oxygen, and low positive end-expiratory pressure. In addition, the nurse must consider the serum potassium, hematocrit, and patient temperature, and administer appropriate medications.

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Hypercyanotic spells caused by antegrade catheterization of the pulmonary arteries in tetralogy of Fallot: fact or fiction?

Cardiology in the Young ◽

10.1017/s1047951100000251 ◽

1991 ◽

Vol 1 (2) ◽

pp. 136-140 ◽

Cited By ~ 2

Author(s):

Ian A. Murdoch ◽

Shakeel A. Qureshi ◽

Rue Dos Anjos ◽

Jonathan M. Parsons ◽

Edward J. Baker ◽

...

Keyword(s):

General Anesthesia ◽

Tetralogy Of Fallot ◽

Cardiac Catheterization ◽

Balloon Dilatation ◽

Pulmonary Arteries ◽

Pulmonary Trunk ◽

Diagnostic Cardiac Catheterization ◽

Pulmonary Arterial ◽

The Mean ◽

Antegrade Catheterization

SummaryBetween January 1985 and March 1990, 66 children with the tetralogy of Fallot underwent 85 cardiac catheterization procedures. The mean age at first procedure was 2.5 years (range 0.1–;14.4 years) and the mean weight was 10.4 kg ( range 2.4–36.0 kg). Diagnostic cardiac catheterization was performed in 60 procedures and balloon dilatation in 25. Hypercyanotic spells had occurred prior to 24 (28%) of the procedures (all the patients being on propranolol) and a systemic-to-pulmonary arterial shunt had been constructed before 28 (33%) procedures. Of the procedures, 54 (64%) were performed under local and 31(36%) under general anesthesia. The pulmonary trunk was entered antegradely in 52 procedures, retrogradely through a shunt in 6 and not entered in 27. Balloon dilatation was performed under general anesthesia on 25 occasions. No procedure was abandoned because of a cyanotic spell. Nine (11%) spells occurred during 86 procedures, one of the procedures being postponed because ofa spell occurring after premedication, the procedure and not, therefore, continuing to catheterization. Five spells occurred before the catheter was positioned in the heart, 2 spells occurred during catheterization. Of the spells, eight occurred during procedures in children who had not had previous shunts. Antegrade entry into the pulmonary trunk in the group with shunts was associated with no spells compared with 6/38 (18%) in the group not having undergone surgery (p<0.l). In the group not undergoing surgery, when the pulmonary trunk was not entered, 1 (5%) spell occurred during 19 procedures compared with 6/38 (18%) when the pulmonary trunk was entered (p<0.4). The only clinically important factor which significantly influenced the incidence of spells was the use of general anesthesia, which was associated with 6/31 (19%) spells compared with local anesthesia which was associated with 2/54 (4%) spells (p<0.026).

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