Anesthetic implications of primary cardiac tumors in infants and children.
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.
Kussman
Barry D
BD
Department of Anesthesia, Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA. barry.kussman@tch.harvard.edu
Devavaram
Prabhakar
P
Hansen
Dolly D
DD
Dinardo
James A
JA
Forbess
Joseph M
JM
Mehrota
Ramji
R
McGowan
Francis X
FX
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