Anesthetic implications of primary cardiac tumors in infants and children

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.