Perioperative complications in children with pulmonary hypertension undergoing noncardiac surgery or cardiac catheterization.
BACKGROUND
Pulmonary arterial hypertension (PAH) can lead to significant cardiac dysfunction and is considered to be associated with an increased risk of perioperative cardiovascular complications.


METHODS
We reviewed the medical records of children with PAH who underwent anesthesia or sedation for noncardiac surgical procedures or cardiac catheterizations from 1999 to 2004. The incidence, type, and associated factors of complications occurring intraoperatively through 48 h postoperatively were examined.


RESULTS
Two hundred fifty-six procedures were performed in 156 patients (median age 4.0 yr). PAH etiology was 56% idiopathic (primary), 21% congenital heart disease, 14% chronic lung disease, 4% chronic airway obstruction, and 4% chronic liver disease. Baseline pulmonary artery pressure was subsystemic in 68% patients, systemic in 19%, and suprasystemic in 13%. The anesthetic techniques were 22% sedation, 58% general inhaled, 20% general IV. Minor complications occurred in eight patients (5.1% of patients, 3.1% of procedures). Major complications, including cardiac arrest and pulmonary hypertensive crisis, occurred in seven patients during cardiac catheterization procedures (4.5% of patients, 5.0% of cardiac catheterization procedures, 2.7% of all procedures). There were two deaths associated with pulmonary hypertensive crisis (1.3% of patients, 0.8% of procedures). Baseline suprasystemic PAH was a significant predictor of major complications by multivariate logistic regression analysis (OR = 8.1, P = 0.02). Complications were not significantly associated with age, etiology of PAH, type of anesthetic, or airway management.


CONCLUSIONS
Children with suprasystemic PAH have a significant risk of major perioperative complications, including cardiac arrest and pulmonary hypertensive crisis.
Carmosino
Mario J
MJ
Department of Anesthesiology, The Children's Hospital and University of Colorado School of Medicine, Denver, Colorado 80218, USA.
Friesen
Robert H
RH
Doran
Aimee
A
Ivy
Dunbar D
DD
D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019990:Perioperative Care; D011651:Pulmonary Artery / Q000473:pathology; D012189:Retrospective Studies