1
|
Odegard KC, Rockoff MA. The "Mother of pediatric cardiac anesthesia": An interview with Dr Dolly D. Hansen, a pioneering woman in medicine. Paediatr Anaesth 2020; 30:964-969. [PMID: 32559358 DOI: 10.1111/pan.13949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/19/2023]
Abstract
Dr Dolly D. Hansen (1935-), Associate Professor in the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, devoted her life to improving the perioperative care of children with congenital heart disease. She applied her knowledge of cardiovascular and pulmonary physiology and the effects on anesthetic agents in children with and without heart disease into clinical practice and thereby greatly influenced the practice of pediatric anesthesia, cardiology, surgery, and critical care medicine. As an exceptional master clinician, leader, program builder, innovator, teacher, and academic role model, she shaped the careers of hundreds of fellows and young attendings, many of whom became leaders in the field.
Collapse
Affiliation(s)
- Kirsten C Odegard
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mark A Rockoff
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Kaynar A, Kelsaka E, Karakaya D, Sungur M, Baris S, Demirkaya M, Sarıhasan B, Baysal K. Effects of Different Doses of Remifentanil Infusion on Hemodynamics and Recovery in Children Undergoing Pediatric Diagnostic Cardiac Catheterization. J Cardiothorac Vasc Anesth 2011; 25:660-4. [DOI: 10.1053/j.jvca.2010.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Indexed: 11/11/2022]
|
3
|
Singh R, Choudhury M, Saxena A, Kapoor PM, Juneja R, Kiran U. Inhaled Nitroglycerin Versus Inhaled Milrinone in Children with Congenital Heart Disease Suffering from Pulmonary Artery Hypertension. J Cardiothorac Vasc Anesth 2010; 24:797-801. [DOI: 10.1053/j.jvca.2009.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Indexed: 11/11/2022]
|
4
|
Goyal P, Kiran U, Chauhan S, Juneja R, Choudhary M. Efficacy of nitroglycerin inhalation in reducing pulmonary arterial hypertension in children with congenital heart disease. Br J Anaesth 2006; 97:208-14. [PMID: 16707530 DOI: 10.1093/bja/ael112] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There has been a renewed interest in nitric oxide donor drugs, such as nitroglycerin, delivered by the inhalational route for treatment of pulmonary arterial hypertension (PAH). We investigated the acute effects of inhaled nitroglycerin on pulmonary and systemic haemodynamics in children with PAH associated with congenital heart disease. METHODS Nineteen children with acyanotic congenital heart disease and a left to right shunt with severe PAH, undergoing routine diagnostic cardiac catheterization were included in this study. Systolic, diastolic and mean systemic as well as pulmonary artery pressures, right atrial pressure and pulmonary capillary wedge pressure (PCWP) were recorded and systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) were calculated at room air, following 100% oxygen as well as after nitroglycerin inhalation in all patients. RESULTS Systolic, diastolic and mean pulmonary artery pressure and PVRI decreased significantly, whereas heart rate, systolic, diastolic and mean systemic arterial pressure, PCWP and SVRI did not change significantly following 100% oxygen or inhalation of nitroglycerin. CONCLUSION Inhaled nitroglycerin significantly decreases systolic, diastolic and mean pulmonary artery pressure as well as PVRI without affecting systemic haemodynamics, and thus can be used as a therapeutic modality for acute reduction of PAH in children with congenital heart disease.
Collapse
Affiliation(s)
- P Goyal
- Department of Cardiac Anaesthesiology, Cardio Thoracic Centre, All India Institute of Medical Sciences, New Delhi 110029, India.
| | | | | | | | | |
Collapse
|
5
|
Gan TJ. Pharmacokinetic and Pharmacodynamic Characteristics of??Medications Used for Moderate Sedation. Clin Pharmacokinet 2006; 45:855-69. [PMID: 16928150 DOI: 10.2165/00003088-200645090-00001] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The ability to deliver safe and effective moderate sedation is crucial to the ability to perform invasive procedures. Sedative drugs should have a quick onset of action, provide rapid and clear-headed recovery, and be easy to administer and monitor. A number of drugs have been demonstrated to provide effective sedation for outpatient procedures but since each agent has its own limitations, a thorough knowledge of the available drugs is required to choose the appropriate drug, dose and/or combination regimen for individual patients. Midazolam, propofol, ketamine and sevoflurane are the most frequently used agents, and all have a quick onset of action and rapid recovery. The primary drawback of midazolam is the potential for accumulation of the drug, which can result in prolonged sedation and a hangover effect. The anaesthetics propofol and sevoflurane have recently been used for sedation in procedures of short duration. Although effective, these agents require monitored anaesthesia care. Ketamine is an effective agent, particularly in children, but there is concern regarding emergence reactions. AQUAVAN injection (fospropofol disodium), a phosphorylated prodrug of propofol, is an investigational agent possessing a unique and distinct pharmacokinetic and pharmacodynamic profile. Compared with propofol emulsion, AQUAVAN is associated with a slightly longer time to peak effect and a more prolonged pharmacodynamic effect. Advances in the delivery of sedation, including the development of new sedative agents, have the potential to further improve the provision of moderate sedation for a variety of invasive procedures.
Collapse
Affiliation(s)
- Tong J Gan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
| |
Collapse
|
6
|
Abstract
BACKGROUND Cardiac catheterization has revolutionized the management of pediatric cardiac disease. There has been little information on adverse events during these cases from an anesthesia viewpoint. The aim of this audit was to determine the incident rate during pediatric cardiac catheterization as contemporaneously reported by the anesthetist and to identify both the types of events and which procedures had the highest risk. METHODS Since 1993, data have been collected prospectively on an audit form for every anesthetic given in our institution, and in-theatre events were recorded on this form. We have reviewed the data collected on pediatric cardiac catheterizations over a period of 9 years. RESULTS A total of 4454 cardiac catheterizations were recorded. The overall incidence of events was 9.3%. Cardiac catheterization with occlusion of a patent ductus arteriosus (PDA) or a secundum atrial septal defect (ASD) had the lowest event rate at 4.2%. The figure for cardiac catheterization with other therapeutic interventions was 11.6 and 9.3% for solely diagnostic cardiac catheterization. The event rate in infants under the age of 1 year was 13.9% compared with 6.7% for those children over the age of 1 year. Of the 253 reports from cardiac catheterizations that could be analyzed further, there were 91 major complications including four deaths, 72 minor complications and 90 other incidents. CONCLUSIONS Adverse events occur more commonly during cardiac catheterization than during pediatric anesthesia in general. Cases with highest risk are those in the under 1 year olds and those including a therapeutic intervention other than PDA or ASD occlusion.
Collapse
Affiliation(s)
- Davinia Bennett
- Department of Anaesthesia, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | | | | |
Collapse
|
7
|
Kogan A, Efrat R, Katz J, Vidne BA. Propofol-ketamine mixture for anesthesia in pediatric patients undergoing cardiac catheterization. J Cardiothorac Vasc Anesth 2004; 17:691-3. [PMID: 14689406 DOI: 10.1053/j.jvca.2003.09.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the safety of a propofol-ketamine mixture to induce and maintain anesthesia in spontaneously breathing pediatric patents during cardiac catheterization. DESIGN Prospective clinical study. SETTING Departments of Cardiothoracic Surgery, Anesthesiology, and Pediatric Anesthesiology in a university hospital. PARTICIPANTS Forty-five children aged 6 months to 16 years with ASA grade II to III undergoing cardiac catheterization. INTERVENTIONS Continuous intravenous infusion of a mixture of propofol (4 mg/mL) and ketamine (2 mg/mL) with spontaneous ventilation. The infusion rate was changed and additional boluses of propofol or/and ketamine were given as needed. Hemodynamic, respiratory, and other variables were recorded during the procedure and recovery. RESULTS Mean dose of ketamine was 26 +/- 8.3 microg/kg/min and of propofol, 68.3 +/- 21.7 microg/kg/min. Changes in heart rate and mean arterial pressure of more than 20% from baseline were observed in 4 and 5 patients, respectively. A transient reduction in oxygen saturation because of hypoventilation was observed in 3 patients and responded to oxygen administration and manual assisted ventilation. No other complications were observed. CONCLUSIONS The propofol-ketamine mixture is a safe, practical alternative for general anesthesia in pediatric patients undergoing cardiac catheterization.
Collapse
Affiliation(s)
- Alexander Kogan
- Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel.
| | | | | | | |
Collapse
|
8
|
Bernath MA, Sekarski N. Management of paediatric patients undergoing diagnostic and invasive cardiology procedures. Curr Opin Anaesthesiol 2001; 14:441-6. [PMID: 17019128 DOI: 10.1097/00001503-200108000-00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since diagnostic cardiac catheterization in children with congenital heart disease was first reported in 1947, echocardiography has been used as a non-invasive diagnostic tool in congenital heart disease, resulting in a decrease in diagnostic cardiac catheterizations. However, the total number of cardiac catheterizations remained at a steady level until the mid-1980s and has since increased progressively. This is a result of the introduction of interventional transcatheter techniques to improve or correct congenital heart malformations. Since the first description of balloon atrial septostomy, the range of indications for such techniques has steadily increased, particularly in the past 15 years. 'Deep' sedation or general anaesthesia is essential for the conduct of cardiac catheterization in children, particularly in the younger age group.
Collapse
Affiliation(s)
- M A Bernath
- Anesthesiology Department, CHUV, CH-1011 Lausanne, Switzerland.
| | | |
Collapse
|
9
|
Mossad EB. Pericardial effusion--a life saver! J Cardiothorac Vasc Anesth 1998; 12:673-5. [PMID: 9854666 DOI: 10.1016/s1053-0770(98)90241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- E B Mossad
- Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, OH 44195, USA
| |
Collapse
|
10
|
King FG, LeDez KM. Anaesthesia care and the adult cardiac catheterization patient. Curr Opin Anaesthesiol 1998; 11:417-23. [PMID: 17013253 DOI: 10.1097/00001503-199808000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The number and types of procedures being performed in the adult cardiac catheterization suite have increased dramatically, with an aggressive move towards percutaneous interventional cardiac procedures. Here we review many of these procedures, including the current trends in North America and Europe. Coronary angioplasty is now more commonly performed than coronary artery bypass grafting. The past 5 years have seen a proliferation of coronary stenting procedures. Restenosis of coronary arteries continues to be a major area of research and concern.
Collapse
Affiliation(s)
- F G King
- Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | | |
Collapse
|
11
|
Bubien RS, Fisher JD, Gentzel JA, Murphy EK, Irwin ME, Shea JB, Dick M, Ching E, Wilkoff BL, Benditt DG. NASPE expert consensus document: use of i.v. (conscious) sedation/analgesia by nonanesthesia personnel in patients undergoing arrhythmia specific diagnostic, therapeutic, and surgical procedures. Pacing Clin Electrophysiol 1998; 21:375-85. [PMID: 9507538 DOI: 10.1111/j.1540-8159.1998.tb00061.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Use of IV (Conscious) Sedation/Analgesia by Nonanesthesia Personnel in Patients Undergoing Arrhythmia Specific Diagnostic, Therapeutic, and Surgical Procedures. This article is intended to inform practitioners, payers, and other interested parties of the opinion of the North American Society of Pacing and Electrophysiology (NASPE) concerning evolving areas of clinical practice or technologies or both, that are widely available or are new to the practice community. Expert consensus documents are so designated because the evidence base and experience with the technology or clinical practice are not yet sufficiently well developed, or rigorously controlled trials are not yet available that would support a more definitive statement. This article has been endorsed by the American College of Cardiology, October 1997.
Collapse
|
12
|
Heng JT, De Giovanni JV. Occlusion of persistent left superior vena cava to unroofed coronary sinus using vena cava filter and coils. Heart 1997; 77:579-80. [PMID: 9227308 PMCID: PMC484807 DOI: 10.1136/hrt.77.6.579] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 48 year old female with complex cyanotic heart disease and pulmonary hypertension was partly cyanosed because of a persistent left superior vena cava draining into an unroofed coronary sinus. The left superior vena cava, which measured 22 mm in diameter, was successfully occluded with a Günther Tulip Vena Cava Mreye Filter which acted as a barrier for embolisation coils.
Collapse
Affiliation(s)
- J T Heng
- Heart Unit, Birmingham Children's Hospital, NHS Trust, United Kingdom
| | | |
Collapse
|
13
|
Abstract
PURPOSE To see if the authors of review articles in anaesthesia journals are making use of systematic methods in their preparation. METHODS Twenty-five review articles published in 1995 in four major anaesthesia journals were analysed and compared with standard guidelines for the appraisal of reviews. RESULTS Of the 25 articles, only 14 stated a clear purpose. Only two revealed the search strategy used to identity articles for the review. None of the reviews featured any type of quality assessment of the primary studies included, or stated what criteria, if any, were used to determine what material was included or excluded. Useful areas for future research were highlighted in only seven reviews. CONCLUSION There is little evidence that reviews currently accepted for publication in anaesthesia journals have been prepared systematically.
Collapse
Affiliation(s)
- A F Smith
- Department of Anaesthesia, Manchester Royal Infirmary, United Kingdom
| |
Collapse
|
14
|
Jonmarker C. Patients with congenital heart malformations for noncardiac surgery. ACTA ANAESTHESIOLOGICA SCANDINAVICA. SUPPLEMENTUM 1997; 110:104-5. [PMID: 9248552 DOI: 10.1111/j.1399-6576.1997.tb05520.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Most patients with CHD can be safely anesthetized with regular techniques. Preoperative consultation with appropriate specialists and a well planned anesthetic management is important.
Collapse
Affiliation(s)
- C Jonmarker
- Department of Anesthesia and Intensive Care, Lund University Hospital, Sweden
| |
Collapse
|