Perioperative Complications in Children With Pulmonary Hypertension Undergoing Noncardiac Surgery or Cardiac Catheterization
Mario J. Carmosino,* Robert H. Friesen,* Aimee Doran,† and Dunbar D. Ivy†
(Anesth Analg, 104:521-527, 2007)
Departments of *Anesthesiology and †Pediatrics (Cardiology), The Children's Hospital and University of Colorado School of Medicine, Denver, CO.
Pulmonary arterial hypertension (PAH) can lead to marked cardiac dysfunction and is considered to be associated with an increased risk of perioperative cardiovascular complications. The medical records of children with PAH who underwent anesthesia or sedation for noncardiac surgical procedures or cardiac catheterization from 1999 to 2004 were reviewed. The incidence, type, and associated factors of complications that occurred intraoperatively through 48 hours postoperatively were examined. Two hundred fifty-six procedures were performed in 156 patients (median age, 4 years). The etiology of PAH was idiopathic (primary) in 56%, congenital heart disease in 21%, chronic lung disease in 14%, chronic airway obstruction in 4%, and chronic liver disease in 4%. Baseline pulmonary artery pressure was subsystemic in 68% of patients, systemic in 19%, and suprasystemic in 13%. The anesthetic techniques used were sedation in 22%, general inhaled in 58%, and general intravenous in 20%. Minor complications were noted in 8 patients (5.1% of patients, 3.1% of procedures). Major complications, including cardiac arrest and pulmonary hypertensive crisis, occurred in 7 patients during cardiac catheterization procedures (4.5% of patients, 5.0% of cardiac catheterization procedures, 2.7% of all procedures). Two deaths associated with pulmonary hypertensive crisis (1.3% of patients, 0.8% of procedures) occurred. Baseline suprasystemic PAH was an important predictor of major complications by multivariate logistic regression analysis (odds ratio = 8.1). Complications were not markedly associated with age, etiology of PAH, type of anesthetic, or airway management. It was concluded that children with suprasystemic PAH are at a substantial risk for major perioperative complications, including cardiac arrest and pulmonary hypertensive crisis.