Case series: Dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery
Case 5 was a 2-year-old boy who was diagnosed as TOF with a large subaortic VSD, bidirectional shunt, severe pulmonic stenosis, and overriding of aorta with a small sized pulmonary artery on echocardiography.[] The child had developed right hemiparesis at 1 year of age and his heart disease was detected during the work up. He recovered well over the next few months, but could not undergo any palliative surgery for TOF. He developed a malignant right parietal lobe infarct with features of raised ICP at 2 years of age. A decompressive right hemicraniectomy was done under general anesthesia. The child developed cerebrospinal fluid (CSF) leak from the surgical site and an external lumbar drain was placed 3 days later for controlled CSF drainage. During both the above procedures, dexmedetomidine (1 g/kg and 1-1.5 g/kg/h) and ketamine (2 mg/kg and 2-2.5 mg/kg/h), respectively were used for induction and maintenance of anesthesia. The former surgery was done with controlled ventilation using muscle relaxation and the latter procedure was carried out with the two drugs along with oxygen via face mask with spontaneous respiration. The child maintained hemodynamic stability perioperatively and recovered uneventfully.