title: Anesthetic implications of primary cardiac tumors in infants and children.
abstract: OBJECTIVE
  To determine the degree of hemodynamic and airway compromise in infants and children undergoing anesthesia for primary cardiac tumors.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary-care, academic children's hospital.
  
  
  METHODS
  Patients <18 years old who had undergone anesthesia and surgery for resection or biopsy of a primary cardiac tumor (n = 25).
  
  
  METHODS
  None.
  
  
  RESULTS
  Charts were reviewed for intraoperative complications, defined as (1) hypotension (20% decrease from baseline) during or after induction; (2) failure to gain airway control by insertion of an airway or endotracheal intubation, inability to ventilate after administration of a muscle relaxant, need for change in patient position, rigid bronchoscopy, or cardiopulmonary bypass for adequate oxygenation; and (3) new arrhythmias. Hypotension during induction occurred in 4 patients (16%), 3 of whom were hemodynamically unstable preoperatively. Hypotension after induction was found in 2 (8%) patients. Hypotension occurred more frequently in patients with obstruction to blood flow and arrhythmia (n = 3), obstruction to blood flow only (n = 1), and arrhythmia only (n = 1). No patient had airway difficulty related to the tumor, although one intrapericardial tumor mimicked an anterior mediastinal mass. New arrhythmias occurred in 3 (12%) patients.
  
  
  CONCLUSIONS
  The subgroup of patients at greatest risk are patients with a combination of obstruction to blood flow and arrhythmias. Despite the alarming diagnosis, the intraoperative course tends to be fairly stable in most cases. Extensive pericardial tumors may produce the same airway concerns as anterior mediastinal masses, but airway complications do not seem to be a problem with intrachamber tumors.
authors.affiliation: Department of Anesthesia, Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA. barry.kussman@tch.harvard.edu
authors.forename: Barry D
authors.initials: BD
authors.lastname: Kussman
authors.forename: Prabhakar
authors.initials: P
authors.lastname: Devavaram
authors.forename: Dolly D
authors.initials: DD
authors.lastname: Hansen
authors.forename: James A
authors.initials: JA
authors.lastname: Dinardo
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Forbess
authors.forename: Ramji
authors.initials: R
authors.lastname: Mehrota
authors.forename: Francis X
authors.initials: FX
authors.lastname: McGowan
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000379:methods*; D002405:Catheterization, Central Venous; D002648:Child; D002675:Child, Preschool; D005260:Female; D006338:Heart Neoplasms / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D012189:Retrospective Studies