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      Transient Pulmonary Atelectasis after Ketamine Sedation during Cardiac Catheterization in Spontaneously Breathing Children with Congenital Heart Disease

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          Abstract

          Background: Ketamine is applied widely for sedation during cardiac catheterization in spontaneously breathing children with congenital heart disease (CHD). However, a rare and unreported respiratory complication, transient and reversible atelectasis of lungs (TRAL), was identified.

          Purpose: The study was performed to investigate retrospectively the prevalence and clinical characteristics of TRAL after ketamine sedation in pediatric cardiac catheterization.

          Methods: Four thousand four hundred and seventy-four sick children were sedated with ketamine, and pediatric cardiac catheterization was carried out under spontaneous breathing. TRAL was detected in 33 children (17 M/16 F, age was 2.1±1.7 years) by retrospective analysis. The clinical and radiographic characteristics were recorded before, during and after TRAL.

          Results: In pediatric cardiac catheterization, the prevalence of TRAL was 0.74% after ketamine sedation. TRAL occurred in 23 children with cyanotic CHD, and 10 with acyanotic CHD. All TRALs had common clinical and radiographic features: the diffuse opacity of bilateral lungs developed rapidly (identified under X-ray fluoroscopy), associated with decrease in lung volume, and then the decrease in SpO 2 (94.2±9.2% vs. 59.4±2.2%, P<0.05), and heart rates (143.5±14.3 bpm vs. 58.3±9.7 bpm, P<0.05) followed quickly. TRAL was relieved by supportive oxygen in 32 children (23 with face mask, and 9 with endotracheal intubation), and the duration of TRAL was 1.6±0.5 minutes. However, TRAL caused the death of one child.

          Conclusions: TRAL is a rare and urgent respiratory complication after ketamine sedation, and the mechanism is unclear. Rapid and diffuse opacity of bilateral lungs is the earliest sign of TRAL in pediatric cardiac catheterization, and the immediate supportive oxygen is crucial.

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          Most cited references 17

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          Computerized tomography of the chest and gas exchange measurements during ketamine anesthesia.

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            Pulmonary vascular-bronchial interactions acute reduction in pulmonary blood flow alters lung mechanics

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              Hemodynamic effects of ketamine in children with congenital heart disease

               JP Morray,  A. Lynn,  SJ Stamm (1984)
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                Author and article information

                Journal
                CVIA
                Cardiovascular Innovations and Applications
                CVIA
                Compuscript (Ireland )
                2009-8618
                2009-8618
                May 2016
                July 2016
                : 1
                : 3
                : 351-359
                Affiliations
                1Interventional Radiology, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
                2Radiology Imaging Center, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
                Author notes
                Correspondence: Zhao Shihua, PhD, MD, FESC, Radiology Imaging Center, National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China, Tel.: +8610-88398158, Fax: +8610-68313012, E-mail: cjr.zhaoshihua@ 123456vip.163.com
                Article
                cvia20160019
                10.15212/CVIA.2016.0019
                Copyright © 2016 Cardiovascular Innovations and Applications

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by/4.0/.

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