Williams Glyn D, Maan Harjot, Ramamoorthy Chandra, Kamra Komal, Bratton Susan L, Bair Ellen, Kuan Calvin C, Hammer Gregory B, Feinstein Jeffrey A
Division of Pediatric Cardiology, Department of Anesthesia, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA.
Paediatr Anaesth. 2010 Jan;20(1):28-37. doi: 10.1111/j.1460-9592.2009.03166.x.
Pulmonary arterial hypertension (PAH) is associated with significant perioperative risk for major complications in children, including pulmonary hypertensive crisis and cardiac arrest. Uncertainty remains about the safety of ketamine anesthesia in this patient population.
Retrospectively review the medical records of children with PAH to ascertain the nature and frequency of peri-procedural complications and to determine whether ketamine administration was associated with peri-procedural complications.
Children with PAH (mean pulmonary artery pressure > or =25 mmHg and pulmonary vascular resistance index > or =3 Wood units) who underwent general anesthesia for procedures during a 6-year period (2002-2008) were enrolled. Details about the patient, PAH, procedure, anesthetic and postprocedural course were noted, including adverse events during or within 48 h of the procedure. Complication rates were reported per procedure. Association between ketamine and peri-procedural complications was tested.
Sixty-eight children (median age 7.3 year, median weight 22 kg) underwent 192 procedures. Severity of PAH was mild (23%), moderate (37%), and severe (40%). Procedures undertaken were major surgery (n = 20), minor surgery (n = 27), cardiac catheterization (n = 128) and nonsurgical procedures (n = 17). Ketamine was administered during 149 procedures. Twenty minor and nine major complications were noted. Incidence of cardiac arrest was 0.78% for cardiac catheterization procedures, 10% for major surgical procedures and 1.6% for all procedures. There was no procedure-related mortality. Ketamine administration was not associated with increased complications.
Ketamine appears to be a safe anesthetic option for children with PAH. We report rates for cardiopulmonary resuscitation and mortality that are more favorable than those previously reported.
肺动脉高压（PAH）与儿童重大手术围手术期发生严重并发症的风险相关，这些并发症包括肺动脉高压危象和心脏骤停。对于这一患者群体，氯胺酮麻醉的安全性仍不确定。
回顾性分析PAH患儿的病历，以确定围手术期并发症的性质和发生率，并确定氯胺酮的使用是否与围手术期并发症相关。
纳入在6年期间（2002 - 2008年）因手术接受全身麻醉的PAH患儿（平均肺动脉压≥25 mmHg且肺血管阻力指数≥3伍德单位）。记录患者、PAH、手术、麻醉及术后过程的详细信息，包括手术期间或术后48小时内的不良事件。按手术报告并发症发生率。检验氯胺酮与围手术期并发症之间的关联。
68例患儿（中位年龄7.3岁，中位体重22 kg）接受了192例手术。PAH的严重程度为轻度（23%）、中度（37%）和重度（40%）。进行的手术包括大手术（n = 20）、小手术（n = 27）、心导管检查（n = 128）和非手术操作（n = 17）。149例手术使用了氯胺酮。记录到20例小并发症和9例大并发症。心导管检查手术的心脏骤停发生率为0.78%，大手术为10%，所有手术为1.6%。无手术相关死亡。氯胺酮的使用与并发症增加无关。
氯胺酮似乎是PAH患儿的一种安全麻醉选择。我们报告的心肺复苏率和死亡率比先前报告的更有利。
