Case series: Dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery

Abstract

The number of patients with uncorrected congenital cyanotic heart disease is less but at times some may present for non-cardiac surgery with a high anesthetic risk. Some of these may even be adults with compromised cardiopulmonary physiology posing greater challenges to the anesthesiologist. The authors have used a combination of dexmedetomidine and ketamine for anesthesia for non cardiac surgery in five patients with cyanotic heart disease and right to left shunt (3-Eisenmenger's syndrome, 2-Tetralogy of Fallot). The sympathoinhibitory effects of dexmedetomidine were balanced with the cardiostimulatory effects of ketamine, thereby maintaining good cardiovascular stability. The analgesia was good and there was no postoperative agitation. This drug combination was effective and safe for patients with cyanotic heart disease for non cardiac surgeries.

Ketamine: Current applications in anesthesia, pain, and critical care

“…[ 17 ] Ketamine appears as a good alternative to sevoflurane for induction in patients with congenital heart disease where it preserves intra- and post-operative hemodynamic stability. [ 18 19 ] Burns: Ketamine has been widely used to provide analgesia in burn dressing changes, during excision and grafting and for sedation. [ 20 ] It has a major role in repeated anesthetics for burns dressings.…”

“…[ 17 ] Ketamine appears as a good alternative to sevoflurane for induction in patients with congenital heart disease where it preserves intra- and post-operative hemodynamic stability. [ 18 19 ]…”

Anaesthetic management for drainage of frontoparietal abscess in a patient of uncorrected Tetralogy of Fallot

“…[ 5 ] Adequate hydration reduces increased blood viscosity, sludging and thromboembolism. [ 6 ] Hypovolemia can exacerbate the right ventricular outflow tract obstruction if the patient has infundibular stenosis. Maintaining higher systemic vascular resistance (SVR) relative to pulmonary vascular resistance (PVR) minimises right-to-left shunting.…”

“…[ 8 ] Combination of dexmedetomidine and ketamine has been used in two patients of uncorrected TOF for surgeries under general anaesthesia. [ 6 ]…”

Differential cyanosis and undiagnosed eisenmenger′s syndrome: The importance of pulse oximetry

“…A recent case series[6] highlighted the usability of dexmeditomidine – ketamine for inducing 5 adolescents for NCS other than cleft reparative surgery, without causing any additional morbidity. As per the existing literature on facial clefts with associated cardiovascular malformation, the present case report should be the first published article of eisenmenger physiology for palate surgery.…”