Anesthesia for children with pericardial effusion: a case series

Area of Science:

• Pediatric Anesthesiology
• Cardiothoracic Surgery
• Critical Care Medicine

Background:

• Anesthesia for pericardial effusion in children is challenging due to potential hemodynamic compromise during induction.
• Limited literature exists on pediatric anesthetic management for pericardial effusion, with only one case report previously published.

Purpose of the Study:

• To review anesthetic management for children undergoing surgery for pericardial effusion.
• To determine the frequency and nature of complications associated with this procedure.
• To identify risk factors predicting perioperative complications in pediatric patients.

Main Methods:

• Retrospective case review of pediatric patients (1999-2008) who received general anesthesia for surgical treatment of pericardial effusion.
• Analysis of anesthetic techniques, induction agents, and perioperative outcomes.
• Statistical analysis to identify predictors of complications.

Main Results:

• Sixty-five children underwent 79 anesthetics; 84% developed effusions post-cardiac surgery.
• Ketamine was the most common induction agent (38%); 80% were intubated and ventilated.
• 11% experienced major complications, and 22% had minor complications. Preoperative tachypnea and cardiac tamponade predicted major complications; hypoxia predicted all complications.

Conclusions:

• Anesthesia for pediatric pericardial effusion is associated with adverse events in one-third of patients.
• Preoperative tachypnea and cardiac tamponade are predictors of major complications.
• Preoperative hypoxia predicts overall complications, guiding risk assessment and management strategies.