TYK199

During induction of anesthesia, a 6-month-old female with Tetralogy of Fallot becomes increasingly hypercyanotic. Appropriate management could include all the following EXCEPT:

a) Increasing preload to the right ventricle

b) β-blockade to reduce right ventricular infundibular spasm

c) Elevation of the lower extremities

d) Phentolamine bolus

e) Morphine bolus

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Answer

Answer d.

Hypercyanotic “tet” spells are caused by right-to-left shunt, and can occur during induction of anesthesia due to RV infundibular spasm causing subpulmonary obstruction. Treatment includes deepening anesthesia, improving preload, increasing SVR, morphine boluses and β-blockade to reduce infundibular spasm. Phenylephrine may provide benefit by increasing SVR; phentolamine is an α-antagonist that will decrease SVR and increase right-to-left shunting and cyanosis.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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