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One shot spinal morphine injection for postthoracotomy pain control in children

remained stable. No further fluid was suctioned from the trachea. The estimated blood loss was 15 ml. Recovery was uneventful compared with the preceding event. He was ventilated on oxygen and reversed, awakened after three minutes and was extubated after five minutes and transferred to an incubator and spent an hour in the Recovery Room. The hemoglobin was found to be 8 gÆdl )1 and blood was transfused in the immediate postcatheter period. Oxygen was required to keep the saturation at the precatheter level of 85% over the first night, but he was discharged on the second hospital day. Cardiac catheterization of small children has a mortality of approximately 0.6%. There is a higher mortality in children with congenital cyanotic heart disease, and this may be related to the fact that they are also more likely to be in heart failure and have abnormal anatomy. The signs of heart failure in infants have a different pattern to adults. Lung signs are not common; feeding difficulties, long feeding time, sweating during feeding are prominent. The liver may be palpable. Cardiovascular signs, tachycardia and gallop may be difficult for anesthetists to identify. The child, we describe, was in treated heart failure. Uncommon events may occur during catheterization which are life threatening and our policy is that consultant anesthetists should give these anesthetics. We have identified a previous case report in the European literature (1). Surprisingly, that child also had a worsened cough for the first postcatheter day and no other sequelae identified. Goldstein reported another from America (2). We have also found a case report where the flow is in the opposite direction to our case, that is, from a bronchogram to a vertebral embolus (3). We thought that an account of inadvertent bronchography during catheterization with successful conservative management would be of interest, considering intuitively one would expect the results to be disastrous. A Almenrader F R C A Oliver Dearlove F R C A Royal Manchester Children’s Hospital, Manchester M27 4HA, UK (email: o.dearlove@man.ac.uk)