# Combination of high-flow nasal oxygen and ketamine/dexmedetomidine sedation for diagnostic catheterization in a child with pulmonary arterial hypertension: a case report

## TL;DR

A 12-year-old child with severe pulmonary hypertension successfully had a heart procedure using a safe sedation and oxygen strategy.

## Contribution

A safe sedation strategy combining ketamine/dexmedetomidine and high-flow nasal oxygen for children with pulmonary hypertension.

## Key findings

- Ketamine and dexmedetomidine had minimal effect on pulmonary vasculature in the child.
- High-flow nasal oxygen improved ventilation and oxygenation during sedation.
- The strategy enhanced procedural safety for children with life-threatening pulmonary hypertension.

## Abstract

Pulmonary hypertension is associated with significant risk of perioperative life-threatening events. We present a case of a 12-year-old child with severe pulmonary arterial hypertension who successfully underwent diagnostic cardiac catheterization under ketamine and dexmedetomidine sedation with the support of high-flow nasal oxygen. Ketamine and dexmedetomidine are reported to have minimal effect on pulmonary vasculature in children with pulmonary hypertension and can be safely used in this population along with its lack of respiratory depression. Positive pressure generated by high-flow nasal oxygen improves upper airway patency, prevents micro-atelectasis, and is shown to improve the effectiveness of ventilation and oxygenation in patients under sedation breathing spontaneously. The presented strategy may contribute to enhancing the safety and effectiveness of procedural sedation for children with life-threatening pulmonary hypertension.