title: Acute management of a cyanotic episode in an infant after a Norwood procedure.
abstract: In infants with a Norwood stage I reconstruction, the respiratory management to direct pulmonary to systemic blood flow ratio is of critical importance. Disturbance of this delicate blood-flow balance can occur causing rapid deterioration of the infant's condition requiring urgent interventions. However, the emergency staff personnel that are generally the first to be called may not be familiar with these patients' complex pathophysiology. We report on the resuscitation of an infant with a Norwood circulation who developed deep central cyanosis in an out-of-hospital environment. The infant deteriorated because of stenoses in both the neoaortic arch and the aortopulmonary shunt. Emergency therapy, especially for out-of-hospital treatment, can only consist of basic measures, which are discussed.
authors.affiliation: Department of Anaesthesia, University of Basel/Kantonsspital, University Children's Hospital, Basel, Switzerland. hans.ginz@unibas.ch
authors.forename: Hans F
authors.initials: HF
authors.lastname: Ginz
authors.forename: Martin
authors.initials: M
authors.lastname: Stotz
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Erb
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Ummenhofer
mesh_terms: D000208:Acute Disease; D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000503:physiopathology* / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D001807:Blood Vessel Prosthesis; D006328:Cardiac Catheterization / Q000379:methods; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis; D003326:Coronary Circulation / Q000502:physiology; D003490:Cyanosis / Q000209:etiology* / Q000628:therapy; D004632:Emergency Medical Services; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications* / Q000601:surgery; D007223:Infant; D017214:Laryngeal Masks; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000601:surgery; D012121:Respiration, Artificial / Q000379:methods*; D012769:Shock / Q000150:complications* / Q000628:therapy