Intraoperative Cardiac Arrest: Immediate Treatment and Diagnostic Evaluation

Although perioperative cardiac arrest during anesthetic care in infants and children is a rare event, its consequences can be devastating. Risk factors associated with perioperative cardiac arrest include cardiac surgery, younger age, presence of comorbid conditions and emergency surgery. Although medication-related etiologies formerly predominated, the elimination of halothane from anesthetic care has resulted in a shift in etiology to hemodynamic events related to blood loss or hyperkalemia associated with the rapid administration of blood products. Rarely, cardiac arrest can be sudden and unexpected without an obvious pre-existing etiology in an otherwise apparently healthy patient. We present a 16-month-old child who experienced a sudden cardiac arrest following anesthetic induction for a routine urologic procedure. The potential etiology of cardiac arrest during anesthesia is reviewed, keys to resuscitation discussed, and an outline for the investigative work-up presented.