Tet spell – phenylephrine — RACP Paediatrics MCQ

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HardCardiologyTet spell – phenylephrineRACP Paediatrics

Despite all above measures, the infant remains profoundly cyanotic with worsening acidosis. What is the next intervention to increase systemic vascular resistance?

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Correct answer: A — IV phenylephrine

IV phenylephrine (a pure alpha-1 agonist) increases SVR, thereby reducing right-to-left shunting and improving pulmonary blood flow. It is used for refractory tet spells unresponsive to positioning, oxygen, fluids, and morphine. If all medical management fails, emergency surgical intervention (BT shunt or complete repair) may be necessary.

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