Intravenous Sedation in a Child with Intellectual Disability and a History of a Glenn Procedure

Abstract

  We performed intravenous sedation for the extraction of deciduous teeth in a 9-year-old boy with hypoplastic left heart syndrome (HLHS) and intellectual disability who had previously undergone a Glenn procedure. He had previously been diagnosed as having HLHS and had undergone pulmonary artery banding, a Norwood procedure and a Glenn procedure. However, he had not yet undergone a Fontan operation because of the poor growth of the pulmonary vascular bed. After the Glenn procedure, a shunt that allowed the mixing of venous blood from the inferior vena cava and arterial blood from the pulmonary vein was left in place, and pulse oximetry showed an Spo₂ of 85% oxygen saturation with the provision of 1 l/min of oxygen in everyday life. Furthermore, he had severe intellectual disability and could hardly communicate. He had experienced episodes of cyanosis because of agitation and crying during rehabilitation. To prevent cyanosis as a result of agitation and crying, we decided to extract the deciduous teeth under anesthesia management. Intravenous sedation was selected because of the minimally invasive and short-term surgery. Intravenous sedation was induced and maintained using ketamine to avoid circulatory and respiratory suppression. Cyanosis did not occur, and no significant changes in the patient’s vital signs were observed throughout the period of intravenous sedation. Although ketamine increases airway secretion, no problems with airway management occurred in the present case. Intravenous sedation with ketamine is likely to be a safe and effective management for patients who have undergone a Glenn procedure.