Anesthetic implications of primary cardiac tumors in infants and children

Barry D. Kussman, Prabhakar Devavaram, Dolly D. Hansen, James A. DiNardo, Joseph M. Forbess, Ramji Mehrota, Francis X. McGowan

Research output: Contribution to journalArticle

7 Citations (Scopus)

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 intra-operative 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.

Original languageEnglish (US)
Pages (from-to)582-586
Number of pages5
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume16
Issue number5
DOIs
StatePublished - Oct 2002

Fingerprint

Heart Neoplasms
Anesthetics
Cardiac Arrhythmias
Hypotension
Neoplasms
Anesthesia
Airway Management
Intratracheal Intubation
Intraoperative Complications
Bronchoscopy
Tertiary Healthcare
Cardiopulmonary Bypass
Retrospective Studies
Hemodynamics
Biopsy
Muscles

Keywords

  • Anesthesia
  • Cardiac tumors
  • Pediatrics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kussman, B. D., Devavaram, P., Hansen, D. D., DiNardo, J. A., Forbess, J. M., Mehrota, R., & McGowan, F. X. (2002). Anesthetic implications of primary cardiac tumors in infants and children. Journal of Cardiothoracic and Vascular Anesthesia, 16(5), 582-586. https://doi.org/10.1053/jcan.2002.126952

Anesthetic implications of primary cardiac tumors in infants and children. / Kussman, Barry D.; Devavaram, Prabhakar; Hansen, Dolly D.; DiNardo, James A.; Forbess, Joseph M.; Mehrota, Ramji; McGowan, Francis X.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 16, No. 5, 10.2002, p. 582-586.

Research output: Contribution to journalArticle

Kussman, BD, Devavaram, P, Hansen, DD, DiNardo, JA, Forbess, JM, Mehrota, R & McGowan, FX 2002, 'Anesthetic implications of primary cardiac tumors in infants and children', Journal of Cardiothoracic and Vascular Anesthesia, vol. 16, no. 5, pp. 582-586. https://doi.org/10.1053/jcan.2002.126952
Kussman, Barry D. ; Devavaram, Prabhakar ; Hansen, Dolly D. ; DiNardo, James A. ; Forbess, Joseph M. ; Mehrota, Ramji ; McGowan, Francis X. / Anesthetic implications of primary cardiac tumors in infants and children. In: Journal of Cardiothoracic and Vascular Anesthesia. 2002 ; Vol. 16, No. 5. pp. 582-586.
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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 intra-operative 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.",
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