Tet spell – morphine — RACP Paediatrics MCQ

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ModerateCardiologyTet spell – morphineRACP Paediatrics

Knee-chest positioning and supplemental oxygen have been initiated but the infant remains deeply cyanotic with SpO2 60%. IV access is in situ. What is the most appropriate next pharmacological intervention?

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Correct answer: A — IV morphine/fentanyl

IV morphine (0.1 mg/kg) or fentanyl reduces agitation and decreases pulmonary vascular resistance. It also suppresses the respiratory drive that contributes to the hypercyanotic spell. If this is insufficient, an IV fluid bolus (10-20 mL/kg) increases preload. IV phenylephrine (alpha-agonist) can be used to increase SVR in refractory cases.

Reference: RCH Melbourne – 2023 – Tet Spell Management CPG; RACP Paediatric Curriculum – Cardiology