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Article description

Summary:

• To determine the incidence of clinically significant serious adverse events in a contemporary population of pediatric patients with pulmonary hypertension who require anesthesia and identify factors associated with adverse outcomes.
• A single-center (quaternary-care freestanding children’s hospital) retrospective, cross-sectional study
• The study analyzed 862 procedures in 249 children over a three year period with confirmed pulmonary hypertension regarding major adverse events.
• Inclusion criteria: patients <18yo; confirmed diagnosis of pulmonary hypertension: >3 indexed Woods units; mean pulmonary artery pressure >25mmHg, transpulmonary gradient >6mmHg regardless of pulmonary artery pressure in a univentricular circulation with cavopulmo- nary anastomosis
• Exclusion criterion: Patients with aortopul- monary collaterals as a major source of pulmonary blood flow, as identified by cardiac magnetic resonance imaging, com- puted tomography, or catheterization
• The median age was 1.6 years, and the weight was 9.5 lbs. On index catheterization, median pulmonary artery pressure was 36 mmHg, and the pulmonary vascular resistance was 5.1 indexed Wood units.
• In both cardiac catheterization procedures and noncardiac surgery and diagnostic imaging, a majority of patients underwent general anaesthesia with endotracheal intubation and the use of volatile anesthetics. Ten percent of anesthetics were performed with a natural airway.
• Clinically significant serious events occurred frequently, i.e. in 26% (CI 24-33%) of all encounters in the study.
• In multivariate analysis, younger age (adjusted odds ratio [aOR], 1.4 per year; CI, 1.1-1.9; p = 0.01), location in the catheterization laboratory (aOR, 5.1; CI, 1.7-16; p = 0.004), and longer procedure duration (aOR, 1.3 per 30 minutes; CI, 1.1-1.4; p = 0.001) were associated with serious adverse events. Patients with a tracheostomy in place were less likely to experience an adverse event (aOR, 0.1; CI, 0.04-0.5; p = 0.001).
• However, severity of PH on index catheterization was not associated with clinically significant adverse events.

Conclusions:

• Factors, including younger age, longer procedure duration, and location in the catheterization laboratory, were independently associated with clinically significant serious adverse events.
• while preexisting tracheostomy was associated with fewer clinically significant serious adverse events.
• In this cohort, the echocardiographic findings were not able to effectively discriminate perioperative risk.
• Periods of airway management or manipulation, including induction and emergence from anesthesia, should be considered high-risk periods during anesthesia care of pediatric patients with PH