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Risk of cardiac catheterization under anaesthesia in children with pulmonary hypertension
C J Taylor1, G Derrick, A McEwan
1Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
Children undergoing anesthesia for pulmonary hypertension assessment faced a 6% complication rate, including resuscitation or death. Severe idiopathic pulmonary hypertension may pose the highest risk, especially with symptoms like chest pain or syncope.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Children with primary pulmonary hypertension (PHT) are a high-risk group requiring cardiac catheterization under anesthesia.
- Complications, including death, have occurred during anesthesia in these patients, but the true risk remains unquantified.
Purpose of the Study:
- To quantify the risk of complications, including death, during anesthesia for cardiac catheterization in children with PHT.
- To identify potential risk factors associated with these complications.
Main Methods:
- Retrospective review of clinical records of children with PHT undergoing general anesthesia for pulmonary vascular resistance studies.
- Data collected included disease severity, clinical management, and complications within 24 hours of anesthesia.
Main Results:
- Seventy children with PHT underwent cardiac catheterization over 5 years.
- Four children (6%) required external cardiac massage, with one death.
- All four children experiencing complications had severe PHT (tricuspid regurgitant jet velocity >4 m/s).
Conclusions:
- Anesthesia for cardiac catheterization in children with PHT carries a 6% risk of resuscitation or death.
- The small number of complications precluded determination of specific risk factors.
- Children with severe idiopathic PHT and symptoms like chest pain, syncope, or dizziness may be at highest risk.
Background:
Children with primary pulmonary hypertension (PHT) are a high-risk group who require assessment by cardiac catheterization under anaesthesia. Complications, including death, have occurred during anaesthesia in these patients, but the true risk has not been quantified.
Methods:
The clinical records of children with PHT undergoing general anaesthesia for pulmonary vascular resistance studies were reviewed retrospectively. Data collected included pre-catheter measures of severity of disease, details of clinical management, and complications occurring within 24 h of the start of anaesthesia.
Results:
During the past 5 yr, 75 consecutive patients were catheterized and usable records were available in 70. The age range was 0.1-18 yr (mean 7.1). Four children required external cardiac massage [6% (95% confident limits 1-11%)] and one of these died. Of the four, two had an arrhythmia related to the mechanical effects of catheterization, one was hypotensive during anaesthesia and the other had fatal cardiac failure in recovery. All four had severe PHT as judged by echocardiographic estimation of tricuspid regurgitant jet velocity>4 m s-1.
Conclusions:
Resuscitation or death occurred in 6% of cases. Any associated risk factors could not be determined because the number of complications was too small. Risks may be highest in children with severe idiopathic PHT and symptoms of chest pain, syncope, or dizziness.
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