Perioperative complications in children with pulmonary hypertension undergoing general anesthesia with ketamine.
BACKGROUND
Pulmonary arterial hypertension (PAH) is associated with significant perioperative risk for major complications in children, including pulmonary hypertensive crisis and cardiac arrest. Uncertainty remains about the safety of ketamine anesthesia in this patient population.


OBJECTIVE
Retrospectively review the medical records of children with PAH to ascertain the nature and frequency of peri-procedural complications and to determine whether ketamine administration was associated with peri-procedural complications.


METHODS
Children with PAH (mean pulmonary artery pressure > or =25 mmHg and pulmonary vascular resistance index > or =3 Wood units) who underwent general anesthesia for procedures during a 6-year period (2002-2008) were enrolled. Details about the patient, PAH, procedure, anesthetic and postprocedural course were noted, including adverse events during or within 48 h of the procedure. Complication rates were reported per procedure. Association between ketamine and peri-procedural complications was tested.


RESULTS
Sixty-eight children (median age 7.3 year, median weight 22 kg) underwent 192 procedures. Severity of PAH was mild (23%), moderate (37%), and severe (40%). Procedures undertaken were major surgery (n = 20), minor surgery (n = 27), cardiac catheterization (n = 128) and nonsurgical procedures (n = 17). Ketamine was administered during 149 procedures. Twenty minor and nine major complications were noted. Incidence of cardiac arrest was 0.78% for cardiac catheterization procedures, 10% for major surgical procedures and 1.6% for all procedures. There was no procedure-related mortality. Ketamine administration was not associated with increased complications.


CONCLUSIONS
Ketamine appears to be a safe anesthetic option for children with PAH. We report rates for cardiopulmonary resuscitation and mortality that are more favorable than those previously reported.
Williams
Glyn D
GD
Division of Pediatric Cardiology, Department of Anesthesia, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA. jumbo@stanford.edu
Maan
Harjot
H
Ramamoorthy
Chandra
C
Kamra
Komal
K
Bratton
Susan L
SL
Bair
Ellen
E
Kuan
Calvin C
CC
Hammer
Gregory B
GB
Feinstein
Jeffrey A
JA
D000293:Adolescent; D000768:Anesthesia, General / Q000009:adverse effects*; D000778:Anesthetics, Dissociative / Q000009:adverse effects*; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D006976:Hypertension, Pulmonary / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D000860:Hypoxia / Q000150:complications; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D007649:Ketamine / Q000009:adverse effects*; D008171:Lung Diseases / Q000150:complications; D008297:Male; D016343:Monitoring, Intraoperative; D011651:Pulmonary Artery / Q000502:physiology; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000150:complications
D000778:Anesthetics, Dissociative; D007649:Ketamine