title: Supraventricular tachycardia during pediatric anesthesia: a case series and qualitative analysis.
abstract: OBJECTIVE
  To perform a qualitative analysis of noncardiac patients who developed suspected intraoperative supraventricular tachycardia (SVT) during general anesthesia.
  
  
  METHODS
  Retrospective database analysis and chart review.
  
  
  METHODS
  Operating room of a university-affiliated children's hospital.
  
  
  METHODS
  The records of children without cardiac disease who received general anesthesia at The Children's Hospital of Philadelphia from July 1998 through June 2011 were reviewed. Patients with heart rate values above 180 beats per minute were identified, as were specific medications or key words in the free-text fields of the anesthesia records that would be indicative of a tachyarrhythmia. Each case was reviewed by at least two authors; each patient was assigned a diagnosis classification of "highly suspicious" or "unlikely" SVT. The highly suspicious SVT cases were examined in detail to determine the specific aims.
  
  
  RESULTS
  36 subjects out of a total of 285,353 anesthetics administered during the study period were suspected by the anesthesia care team to have had an episode of intraoperative SVT: 22 were "highly suspicious" events, and 14 were "unlikely" events. The highly suspicious SVT events occurred in all phases of anesthesia, and none led to any hemodynamic instability. Effective treatments included vagal maneuvers, pharmacologic antiarrhythmics, or no treatment if the event resolved spontaneously before treatment. Six patients had outpatient follow-up and three received antiarrhythmic medications to control ongoing SVT.
  
  
  CONCLUSIONS
  SVT during the intraoperative period in noncardiac pediatric patients was uncommon. When it occurred, it was not associated with clinically significant patient morbidity. For some patients, the anesthesia unmasked a predisposition for re-entrant SVT and those patients remained on maintenance antiarrhythmic therapy following discharge home.
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Anesthesiology & Critical Care, The Children's Hospital of Philadelphia, PA 19104, USA.
authors.forename: Chad C
authors.initials: CC
authors.lastname: Cripe
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, PA 19104, USA.
authors.forename: Akash R
authors.initials: AR
authors.lastname: Patel
authors.affiliation: Department of Anesthesiology, The Children's Hospital of Colorado, Aurora, CO 80045, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Markowitz
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
authors.forename: Tiffany S
authors.initials: TS
authors.lastname: Behringer
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Anesthesiology & Critical Care, The Children's Hospital of Philadelphia, PA 19104, USA. Electronic address: litmanr@email.chop.edu.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Litman
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Adenosine; anesthesia complications; desflurane; pediatric anesthesia; sevoflurane; tachycardia supraventricular; vagus nerve stimulation