Sedation of hypercyanotic spells in a neonate with tetralogy of Fallot using dexmedetomidine.
OBJECTIVE
Sedation is an important step in the management of patients with hypercyanotic spells associated with tetralogy of Fallot (TOF) to ameliorate and prevent recurrence of cyanosis. This case report illustrates the effectiveness of dexmedetomidine-induced sedation in the management of hypercyanotic spells in a neonate with TOF.


METHODS
An 8-day-old term newborn patient with TOF showed hypercyanotic spells, as indicated by an abrupt decrease in arterial saturation (SpO2) level measured by a pulse oximeter from 80% to as low as 50%, when the patient became irritable and agitated. We started continuous infusion of dexmedetomidine at a dose of 0.2 microg/kg/min without a loading bolus injection. About half an hour after commencement of dexmedetomidine infusion, the patient reached an acceptable level of sedation, together with a drop in heart rate by approximately 20 beats/min. There was no apparent respiratory depression or marked change in blood pressure. SpO2 was also stable during dexmedetomidine infusion. The patient underwent a successful Blalock-Taussig shunt operation on the next day of admission.


CONCLUSIONS
Dexmedetomidine may be useful for the management of hypercyanotic spells in pediatric patients with TOF.
Senzaki
Hideaki
H
Department of Pediatric Cardiology and Pediatrics, Saitama Heart Institute, Saitama Medical University Hospital, Saitama, Japan. hsenzaki@saitama-med.ac.jp
Ishido
Hirotaka
H
Iwamoto
Yoichi
Y
Taketazu
Mio
M
Kobayashi
Toshiki
T
Katogi
Toshiyuki
T
Kyo
Shunei
S
D001794:Blood Pressure; D003490:Cyanosis / Q000209:etiology / Q000517:prevention & control*; D020927:Dexmedetomidine / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007231:Infant, Newborn; D008297:Male; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery*; D013997:Time Factors
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine