Management of cyanotic spells (anoxic spells) in Tetralogy of Fallot

  • Knee chest position
    • Compresses femoral artery – increases afterload
    • Decreases return of deoxygenated blood from the muscles
  • Humidified oxygen
  • Morphine 0.1 to 0.2 mg/kg SC
    • Decreases pulmonary vascular resistance
    • Blunts the sympathetic drive
  • Propranolol
    • Relieves infundibular spasm by negative ionotropic action
  • Vasopressors (methoxamine IV or IM)
    • Increases afterload
  • Correction of anemia
  • Consider corrective surgery

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