Treatment of Immediately Postoperative Hypercyanotic Spell in an Infant With Continuous Fentanyl Infusion

Abstract

Hypercyanotic spell or TET spell is an emergency life
threatening condition. Sedation is a necessary treatment
aiming to calm, attenuating sympathetic activity and
breaking pathophysiology of TET spells. This case
scenario points out that fentanyl infusion, a commonly
used opioid, can be administered for management of
immediately postoperative TET spell in infants with
Tetralogy of Fallot (TOF).
We present the case of an eight-month old infant with
unrepaired TOF who had TET spell immediately after
operation, and whose oxygen saturation dropped to
65%. The patient did not respond to knee-to-chest
positioning, vasoconstrictor and fluid administration. The
symptoms were improved by sedation, fentanyl was bolus
intravenously following continuous infusion, within a few
minutes. Subsequently, the patient underwent a successful
right modified Blalock-Taussig Shunt procedure on 20th
postoperative day. Conclusion: fentanyl infusion should
be considered as an alternative sedation and analgesia
of choice for postoperative TET spell patients.