Case Report Intraoperative hypercyanosis in a patient with pulmonary artery band: case report and review of the literature ☆ James R. Pierce MD (Staff Surgeon) a, ⁎ , Shalini S. Sharma MD (Resident in Anesthesia) b , Catherine J. Hunter MD (Senior Fellow in Pediatric Surgery) a , Shazia Bhombal MD (Senior Fellow in Cardiology) c , Brian Fagan MD (Staff Cardiologist) d , Yohana Corchado MD (Staff Anesthesiologist) e , Tracy C. Grikscheit MD (Assistant Professor of Surgery) a , Gerald A. Bushman MD (Chief of Cardiac Anesthesia) e a Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA b Department of Anesthesia, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90089, USA c Department of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA d Pacific Pediatric Cardiology Group, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA e Department of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA Received 24 July 2011; revised 11 April 2012; accepted 18 April 2012 Keywords: Congenital heart disease; Hypercyanosis; Intraoperative cyanosis; Pediatric anesthesia; Neonatal surgery; Pulmonary artery band Abstract A case of intraoperative cyanosis in a patient with a common atrioventricular canal palliated with a pulmonary artery (PA) band is presented. The patient's physiology was consistent with cyanosis due to inadequate pulmonary blood flow, and responded quickly to typical interventions used for a hypercyanotic episode in a patient with unrepaired Tetralogy of Fallot. Differences and similarities in the physiology of PA banding compared with Tetralogy of Fallot are presented, including a rationale for treatment options for hemodynamic decompensation occurring in the setting of anesthesia and surgery. © 2012 Elsevier Inc. All rights reserved. 1. Introduction Administration of general anesthesia to a child with unrepaired congenital heart disease presents unique chal- lenges [1,2]. These patients often have complex physiology and response to individual anesthetic agents, and may have significantly diminished cardiac reserves. Guidelines for evidence-based preoperative preparation of the congenital cardiac patient presenting for noncardiac surgery do not exist. The evolving literature suggests that certain congenital cardiac lesions pose increased procedural risk [3–5], especially in infants with single-ventricle lesions palliated with an arterial shunt [6–8]. As complex two-ventricle lesions tend to be corrected during infancy, the frequency at which such infants undergo palliative pulmonary arterial (PA) banding to control pulmonary overcirculation is increasingly rare, and anesthesia ☆ Supported by departmental funding only. ⁎ Correspondence: James R. Pierce, MD, Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd., #100, Los Angeles, CA 90027, USA. Tel.: +1 323 361 8934; fax: +1 323 361 3534. E-mail address: jrpierce@chla.usc.edu (J.R. Pierce). 0952-8180/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jclinane.2012.04.011 Journal of Clinical Anesthesia (2012) 24, 652–655