Children with suspected pulmonary hypertension must undergo extensive and invasive evaluations to establish a definitive diagnosis. A previously healthy 4-year old girl, newly diagnosed with suprasystemic pulmonary hypertension required multiple lung biopsies. Each procedure was associated with significant bleeding. The challenging anesthetic management of lung biopsy in the presence of suprasystemic pulmonary hypertension is described.
Anesthetics/administration & dosage , Biopsy/methods , Hemorrhage/etiology , Hypertension, Pulmonary/diagnosis , Biopsy/adverse effects , Child, Preschool , Female , Humans , Lung Diseases/diagnosis
Dexmedetomidine is an α-2 agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic in pediatric cardiac patients. Cardiac transplant patients may suffer from acute cellular rejection of the cardiac conduction system and, therefore, are at an increased risk of the electrophysiological effect of dexmedetomidine. We present such a patient who had a cardiac arrest while receiving dexmedetomidine during cardiac catheterization. Because acute cellular rejection of the cardiac conduction system is difficult to diagnose, dexmedetomidine should be used with caution in pediatric heart transplant patients.
Adrenergic alpha-2 Receptor Agonists/adverse effects , Cardiac Catheterization , Dexmedetomidine/adverse effects , Heart Arrest/etiology , Heart Transplantation/adverse effects , Hypnotics and Sedatives/adverse effects , Adult , Female , Humans
Plastic bronchitis is potentially a life-threatening complication of long-standing surgically palliated single ventricle congenital heart disease. Patients can present with hypoxia requiring urgent bronchoscopy for removal of bronchial casts. Perioperative care for these patients is challenging and anesthesia is associated with significant cardiac risk. As more surgically corrected single ventricle patients survive to adulthood, these patients are expected to present more frequently. This report details the perioperative management of 2 Fontan patients with hypoxia and significant plastic bronchitis disease burden.
Bronchitis/surgery , Fontan Procedure/adverse effects , Heart Defects, Congenital/complications , Heart Ventricles/abnormalities , Perioperative Care , Shock/therapy , Anesthesia/methods , Child , Female , Humans , Male