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

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Pipat Saeyup


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.

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Case reports


Zachary Z, Avni S, Kerri C, Ali B. Delayed presentation of
Tetralogy of Fallot with isolated cyanosis. Case reports in
pediatrics 2018; Article ID 7412869:1-4.
2. Michelle CW, James MP. Anesthetic management of children
with congenital heart disease for non-cardiac surgery.
Continuing education in anesthesia, Critical care & pain
3. Amruta VH, Sanjat SY. A case of uncorrected adult Tetralogy
of Fallot for emergency decompressive craniotomy: An
anesthetic challenge. Medical journal of Dr. D.Y. Patil
Vidyapeeth 2016;9:768-70.
4. Hideaki S, Hirotaka I, Yoichi I, et al. Sedation of
hypercyanotic spells in a neonate with Tetralogy of Fallot
using dexmedetomidine. J Pediatr (Rio J) 2008; 84: 377-80.
5. Daniel ST, Yaffa MV, Joel B, Thomas JS, Peter SD. Treatment
of Tetralogy of Fallot hypoxic spell with intranasal fentanyl.
Pediatrics 2014;134:266-69.
6. Sanford TJ Jr, Smith NT, Dec silver H, Harrison WK.
A comparison of morphine, fentanyl, and sufentanil
anesthesia for cardiac surgery: induction, emergence and
extubation. Anesth Analg 1986;65:259-66.
7. Benthuysen JL, Folt BD, Smith NT, Sanford TJ Jr, Dec-Silver
H, Westover CJ. Prebypass hemodynamic stability of
sufentanil-02, fentanyl-02 and morphine-02 anesthesia
during cardiac surgery: a comparison of cardiovascular
profiles. J cardiothorac Anesth1988;2:749-57.
8. Freedom RM, Benson LN. Tetralogy of Fallot. In: Freedom
RM, Benson LN, Smallhorn JF, editors. Neonatal heart
diease. Heidelberg: Springer-Verlag; 1992. p 213-24.
9. Green SM, Denmark TK, Cline J, Roghair C, Abd Allah S,
Rothrock SG. Ketamine sedation for pediatric critical care
procedures. Pediatr Emerg Care 2001;17:244-8.