Intraoperative hypercyanotic spells in a paediatric patient with uncorrected tetralogy of Fallot undergoing drainage of intracranial abscess in the prone position

Patients with uncorrected cyanotic congenital heart disease undergoing non-cardiac surgery could be challenging to the anaesthesiologist as these patients are at a high risk for perioperative complications, including hypercyanotic spells. This case report describes the successful anaesthetic management of a paediatric patient with uncorrected tetralogy of Fallot who underwent emergency evacuation of intracranial abscess in the prone position under general anaesthesia. The intraoperative course was complicated by recurrent hypercyanotic spells. This report focuses on the unique considerations, recognition of hypercyanotic spells, its pathophysiology, precipitating factors and corresponding management.