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Anesthetic implications of primary cardiac tumors in infants and children.

Abstract：

OBJECTIVE:To determine the degree of hemodynamic and airway compromise in infants and children undergoing anesthesia for primary cardiac tumors. DESIGN:Retrospective study. SETTING:Tertiary-care, academic children's hospital. PARTICIPANTS:Patients <18 years old who had undergone anesthesia and surgery for resection or biopsy of a primary cardiac tumor (n = 25). INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Charts were reviewed for intraoperative complications, defined as (1) hypotension (20% decrease from baseline) during or after induction; (2) failure to gain airway control by insertion of an airway or endotracheal intubation, inability to ventilate after administration of a muscle relaxant, need for change in patient position, rigid bronchoscopy, or cardiopulmonary bypass for adequate oxygenation; and (3) new arrhythmias. Hypotension during induction occurred in 4 patients (16%), 3 of whom were hemodynamically unstable preoperatively. Hypotension after induction was found in 2 (8%) patients. Hypotension occurred more frequently in patients with obstruction to blood flow and arrhythmia (n = 3), obstruction to blood flow only (n = 1), and arrhythmia only (n = 1). No patient had airway difficulty related to the tumor, although one intrapericardial tumor mimicked an anterior mediastinal mass. New arrhythmias occurred in 3 (12%) patients. CONCLUSIONS:The subgroup of patients at greatest risk are patients with a combination of obstruction to blood flow and arrhythmias. Despite the alarming diagnosis, the intraoperative course tends to be fairly stable in most cases. Extensive pericardial tumors may produce the same airway concerns as anterior mediastinal masses, but airway complications do not seem to be a problem with intrachamber tumors.

journal_name

J Cardiothorac Vasc Anesth

journal_title

Journal of cardiothoracic and vascular anesthesia

authors

Kussman BD,Devavaram P,Hansen DD,Dinardo JA,Forbess JM,Mehrota R,McGowan FX Jr

doi

10.1053/jcan.2002.126952

keywords:

subject

Has Abstract

pub_date

2002-10-01 00:00:00

pages

582-6

issue

5

eissn

1053-0770

issn

1532-8422

pii

S1053077002000642

journal_volume

16

pub_type

杂志文章

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