The literature on anesthetic outcomes in children with pulmonary hypertension is limited. In previously published small retrospective studies, it was shown that children with suprasystemic pulmonary hypertension who undergo anesthesia have unacceptably high complication rates. In the past this led to restricting these patients to undergoing anesthesia for emergent/life-threatening surgeries only. With newer, off-label treatments for pulmonary hypertension, such as endothelin receptor antagonists and phosphodiesterase-5 inhibitors, are rates of anesthetic complications improving?
To answer this question, Dr. Katherine Taylor, Department of Anesthesia, Hospital for Sick Children, Toronto, Ontario, Canada, and colleagues performed a retrospective study of five years’ worth of data, the results of which are discussed in this month’s issue of Anesthesia and Analgesia in the article titled “The Impact of Targeted Therapies for Pulmonary Hypertension on Pediatric Intraoperative Morbidity or Mortality.”
The authors analyzed data collected from 122 patients undergoing 284 procedures. Minor complications were defined as self-limited disturbances in blood pressure, oxygenation, or cardiac rhythm that required either minimal or no therapy. Major complications were defined as hypotension, hypoxia, or arrhythmia that occurred during or within 24 hours of anesthesia that required external cardiac massage, direct current electrical shock, rapid intravenous fluid bolus, inotrope or antiarrhythmic drug administration, unplanned intubation or mechanical ventilation. Forty-three percent of the procedures occurred while the patient was receiving disease-modifying treatments.
The authors found a total of 20 complications (an overall complication rate of 7%), including 3 deaths (1.1% per procedure). Eleven of the complications found were classified as minor (3.9%) and nine were major (3.2%). The only statistically significant characteristics noted to affect complication rate were age and degree of pulmonary hypertension (complications were more likely in patients with suprasystemic disease.) Surprisingly, treatment with disease-modifying drugs was not associated with a reduced complication rate.
As with most studies in the pediatric patient population, interpretation of these results is limited by the retrospective study design. Further studies using data from multiple centers that have large populations of patients with pulmonary hypertension are needed to get a clearer picture of the impact of the newer disease-modifying treatments of pediatric pulmonary hypertension.