Spinal anesthesia after intraoperative cardiac arrest during general anesthesia in an infant

Whitaker, Emmett E; Miler, Veronica; Bryant, Jason; Proicou, Stephanie; Jayanthi, Rama; Tobias, Joseph D

The incidence of cardiac arrest in pediatric patients undergoing general anesthesia has been reported as 1.4 per 10,000, with only 28% surviving to hospital discharge. 15 Risk factors have included younger age, higher American Society of Anesthesiologists' physical status, emergency surgery, and patients with congenital heart disease, especially those with pulmonary hypertension. Of the 150 cardiac arrests reported in the initial Perioperative Cardiac Arrest registry, medication-related (37%) and cardiovascular (32%) causes were the most common, together accounting for 69% of all arrests. 15 Cardiovascular depression from halothane, alone or in combination with other medications, was responsible for two-thirds of all medication-related arrests, being the most common etiologic factor identified. With the transition from halothane to sevoflurane for the inhalational induction of anesthesia, there was a shift noted in the Perioperative Cardiac Arrest registry regarding the etiology of perioperative cardiac arrest. 16 Medication-related cardiac arrests accounted for 18% of all arrests, compared with 37% from the previous survey. 15, 16 Cardiovascular causes of cardiac arrest are now the most common (41% of all arrests), with hypovolemia from blood loss and hyperkalemia from the rapid transfusion of blood being the most commonly identified etiologies.