Abstract
Bradyarrhythmia in children is a real challenge for an anesthesiologist. Blood transfusion-related cardiac arrest may be due to hyperkalemia, citrate toxicity, and severe acidosis. We came across such an emergent situation of unanticipated bradyarrhythmia after packed red blood transfusion in a two-year child having a posterior fossa tumor (medulloblastoma) with features of hydrocephalus. Emergency craniotomy and tumor excision was planned in the prone position. Suggestions to reduce the risk of transfusion-associated hyperkalemic cardiac arrest include the use of fresher RBCs, minimizing the time between irradiation and transfusion, washing older irradiated RBC products, and use a peripheral intravenous catheter to decrease the rate of transfusion.
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