Successful Treatment of Anoxic Spell by Landiolol in an Infant with Tetralogy of Fallot

Abstract

  A 2-year-old male diagnosed as having tetralogy of Fallot (TOF) without an obvious medical history of anoxic spell underwent elective infundibulectomy of right ventricular outflow, pulmonary valvotomy, and patch closure of ventricular septal defect. Abrupt decreases in systolic arterial pressure from 100 to 60mmHg and SpO₂ from 100 to 92% occurred during the maneuver of right atrial cannulation prior to cardiopulmonary bypass. Bolus landiolol 0.4mg/kg for the possible occurrence of anoxic spell restored not only the systemic arterial pressure but also the arterial oxygenation without any occurrences of bradycardia and hypotension through the course. Landiolol is a shorter-acting and less cardiodepressive beta 1 adrenoceptor antagonist than esmolol. This case suggests that landiolol might become a choice among agents treating anoxic spell in pediatric patient with TOF, even if cardiovascular status is unstable.