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Yabrodi M, Abdel-Mageed S, Abulebda K, Murphy LD, Rodenbarger A, Bhai H, Lutfi R, Friedman ML. Deep Sedation in Pediatric Patients With Single Ventricle Physiology Outside of the Operating Room. World J Pediatr Congenit Heart Surg 2024:21501351231211584. [PMID: 38213105 DOI: 10.1177/21501351231211584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background: Advancements in palliative surgery of patients with single ventricle physiology have led to an increase in the need for deep sedation protocols for painful procedures. However, positive pressure ventilation during anesthesia can result in unfavorable cardiopulmonary interactions. This patient population may benefit from sedation from these painful procedures. Methods: This study aims to demonstrate the safety and efficacy of deep sedation by pediatric intensivists outside the operating room for children with single ventricle physiology. This is a single-center, retrospective chart review on consecutive pediatric patients with single ventricle physiology who received deep sedation performed by pediatric intensivists between 2013 and 2020. Results: Thirty-three sedations were performed on 27 unique patients. The median age was 3.7 years (25th%-75th%: 2.1-15.6). The majority of the sedations, 88% (29/33), were done on children with Fontan physiology and 12% (4/33) were status-post superior cavopulmonary anastomosis. The primary cardiac defect was hypoplastic left heart in 63% (17/27) of all sedation procedures. There were 24 chest tube placements and 9 cardioversions. Ketamine alone [median dose 1.5 mg/kg (range 0.8-3.7)], ketamine [median dose 1 mg/kg (range 0.1-2.1)] with propofol [median dose 2.3 mg/kg (range 0.7-3.8)], and ketamine [median dose 1.5 mg/kg (range 0.4-3.0)] with morphine [median dose 0.06 mg/kg (range 0.03-0.20)] were the most common sedation regimens used. Adverse events (AEs) occurred in 4 patients (15%), three of which were transient AEs. All sedation encounters were successfully completed. Conclusion: Procedural deep sedation can be safely and effectively administered to single ventricle patients by intensivist-led sedation teams in selective case.
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Affiliation(s)
- Mouhammad Yabrodi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | | | - Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Lee D Murphy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Andrew Rodenbarger
- Division of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Hamza Bhai
- Marioan University School of Medicine, Indianapolis, IN, USA
| | - Riad Lutfi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Matthew L Friedman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Memeti S, Kuci S, Ibrahimi A, Goga M, Veshti A, Buba S, Baboci A. Perioperative Management of a Child with Hypoplastic Left Heart Syndrome Undergoing Cryptorchidism Surgery. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hypoplastic left heart syndrome (HLHS) is a complex congenital heart condition which includes abnormal development of left sided cardiac structures leading to inadequate systemic perfusion following postnatal closure of the patent ductus arteriosus (PDA).
Surgical palliation may be accomplished through a 3 staged process
-Norwood procedure. This surgery is usually done within the first two weeks of your child's life
-Bidirectional Glenn procedure. This procedure is generally the second surgery. It's done when your child is between 3 and 6 months of age.
-Fontan procedure. This surgery is usually done when your child is between 18 months and 4 years of age.
Patients with HLHS may need to undergo other non-cardiac surgical procedures during the first years of life posing a real challenge to the anesthesiologist, surgeon and the entire medical team.
We present the case of a 18-months old, 9 kg infant who presented for cryptorchidism surgery. Cryptorchidism or undescended testis (UDT) is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. The main reasons for treatment of cryptorchidism include increased risks of impairment of fertility potential, testicular malignancy, torsion and/or associated inguinal hernia.
The intraoperative implications of the hybrid anatomy are discussed, options for anesthetic care presented, and previous reports of anesthetic care for such patients reviewed.
Conclusion: LMA combined with local anesthesia was effective to maintaining optimal cardiac function of this child patient with HLHS
In summary, children with palliated HLHS have anesthetic considerations that must be followed in order to reduce perioperative morbidity and mortality in this high-risk pathology.
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3
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Gorbea M. A Review of Physiologic Considerations and Challenges in Pediatric Patients With Failing Single- Ventricle Physiology Undergoing Ventricular Assist Device Placement. J Cardiothorac Vasc Anesth 2021; 36:1756-1770. [PMID: 34229925 DOI: 10.1053/j.jvca.2021.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/11/2022]
Abstract
Advances in surgical techniques and outpatient cardiac care have led to a growing population of pediatric patients surviving well into adulthood with previous single-ventricle palliation. Continued improvement in survival has resulted in subsequent increases in the number of patients with single-ventricle physiology listed for heart transplantations. Some of these patients require mechanical circulatory support as a bridge to transplantation, although establishing successful mechanical circulatory support in these complex patients remains challenging. Only limited published data exist describing the perioperative anesthetic management and key considerations dedicated to patients with failing single-ventricle physiology presenting for ventricular assist devices. This clinical review aims to provide a focused evaluation of the vital perioperative considerations encountered in this novel population.
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Affiliation(s)
- Mikel Gorbea
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX.
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4
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McNamara JR, McMahon A, Griffin M. Perioperative Management of the Fontan Patient for Cardiac and Noncardiac Surgery. J Cardiothorac Vasc Anesth 2021; 36:275-285. [PMID: 34023201 DOI: 10.1053/j.jvca.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 11/11/2022]
Abstract
The Fontan circulation is the single-ventricle approach to surgical palliation of complex congenital heart disease wherein biventricular separation and function cannot be safely achieved. Incremental improvements in this surgical technique, along with improvements in the long-term medical management of these patients, have led to greater survival of these patients and a remarkably steady increase in the number of adults living with this unusual circulation and physiology. This has implications for healthcare providers who now have a greater chance of encountering Fontan patients during the course of their practice. This has particularly important implications for anesthesiologists because the effects of their interventions on the finely balanced Fontan circulation may be profound. The American Heart Association and American College of Cardiology recommend that, when possible, elective surgery should be performed in an adult congenital heart disease center, although this may not be feasible in the provision of true emergency care. This review article summarizes the pathophysiology pertinent to the provision of anesthesia in this complex patient group and describes important modifications to anesthetic technique and perioperative management.
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Affiliation(s)
- John Richard McNamara
- Department of Anaesthesiology and Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Aisling McMahon
- Department of Anaesthesiology and Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Griffin
- Department of Anaesthesiology and Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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5
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Cummings JJ, Siegrist KK, Deegan RJ, Solórzano CC, Eagle SS. Robotic Adrenalectomy for Pheochromocytoma in a Patient with Fontan Physiology. J Cardiothorac Vasc Anesth 2020; 34:2446-2451. [PMID: 32434722 DOI: 10.1053/j.jvca.2020.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Jared J Cummings
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Kara K Siegrist
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Robert J Deegan
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Carmen C Solórzano
- Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Susan S Eagle
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
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6
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Henry BM, Cheruiyot I, Wong LM, Keet K, Mutua V, Chhapola V, Tubbs RS. The bridging bronchus: A comprehensive review of a rare, potentially life-threatening congenital airway anomaly associated with cardiovascular defects. Pediatr Pulmonol 2019; 54:1895-1904. [PMID: 31468716 DOI: 10.1002/ppul.24488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 07/25/2019] [Indexed: 12/17/2022]
Abstract
The bridging bronchus is a rare congenital airway anomaly in which the right upper lobe of the lung is supplied by the right main bronchus while the right lower lobe, and often the right middle lobe is supplied by an aberrant bronchus arising from the left main bronchus. The aberrant bronchus crosses (bridges) the lower part of the mediastinum, hence the term bridging bronchus (BB). This potentially life-threatening condition, usually accompanied by diffuse or focal airway stenosis, commonly presents with signs and symptoms related to large airway obstruction, such as respiratory distress, apnea, wheezing, stridor, and recurrent respiratory tract infections. Diagnosis of the BB is often challenging because the associated signs and symptoms mimic those of common conditions such as bacterial and viral bronchiolitis, bronchial asthma, cystic fibrosis, and foreign body aspiration. The BB is also often accompanied by congenital cardiovascular anomalies, including left pulmonary artery sling, atrial, and ventricular septal defects, tetralogy of Fallot, patent ductus arteriosus, and coarctation of the aorta. Patients presenting with the above signs and symptoms who are not responsive to standard treatment modalities, and have accompanying cardiovascular congenital anomalies should, therefore, be investigated for the BB. Herein, we review the anatomy, embryology, clinical presentation, differential diagnosis, imaging techniques and surgical management of the BB.
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Affiliation(s)
- Brandon M Henry
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Isaac Cheruiyot
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Linda M Wong
- Department of Anesthesia, The Christ Hospital, Liberty Campus, Cincinnati, Ohio
| | - Kerri Keet
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Division of Clinical Anatomy, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Victor Mutua
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Viswas Chhapola
- Division of Pediatric Intensive Care Unit, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India
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Anesthetic Considerations for Pediatric Patients With Fontan Physiology Undergoing Noncardiac Surgery. Int Anesthesiol Clin 2019; 57:42-60. [DOI: 10.1097/aia.0000000000000250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Gonzalez DO, Ambeba E, Minneci PC, Deans KJ, Nwomeh BC. Surgical site infection after stoma closure in children: outcomes and predictors. J Surg Res 2017; 209:234-241. [DOI: 10.1016/j.jss.2016.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 09/29/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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El-Molla A, Daabiss M, Al-Otaibi R, Al-Qudaihy H, Bawazir S. Bridging bronchus, type six, as a new rare case of a bronchial anomaly. JA Clin Rep 2016; 2:44. [PMID: 29492439 PMCID: PMC5813723 DOI: 10.1186/s40981-016-0070-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/30/2016] [Indexed: 11/12/2022] Open
Abstract
In 1976, Gonzales-Crussi et al. (Am. J. Dis. Child. 130:1015–18, 1976) introduced the first case of bridging bronchus as a rare bronchial branching anomaly; since then, only 14 worldwide cases was described. We suggest our case might be number 15 and could be the first case of type six of this bronchial anomaly. We present a case of a 10-month-old infant with bridging bronchus, congenital tracheal stenosis, and double outlet right ventricle who underwent major laparoscopic surgery for repair of gastrointestinal anomalies to raise awareness of this rare underdiagnosed congenital anomaly and a thorough discussion of the tracheobronchial anomalies and its clinical implications.
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Affiliation(s)
| | - Mohamed Daabiss
- Department of Anesthesia, Pharos University, Canal El Mahmoudia Street, Alexandria, Egypt
| | - Rashed Al-Otaibi
- Department of Anesthesia, Director of Anesthesia Department, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Hussein Al-Qudaihy
- Department of Anesthesia, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Samir Bawazir
- Pediatric Division of Otorhinolaryngology, Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
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10
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Kim J, Sun Z, Englum BR, Allori AC, Adibe OO, Rice HE, Tracy ET. Laparoscopy Is Safe in Infants and Neonates with Congenital Heart Disease: A National Study of 3684 Patients. J Laparoendosc Adv Surg Tech A 2016; 26:836-839. [PMID: 27455201 DOI: 10.1089/lap.2016.0232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Concerns have been raised about the use of laparoscopic surgery (LS) in infants with congenital heart disease (CHD) due to their unique physiology. Prior studies on the safety and effectiveness of laparoscopy in children with CHD are limited in scope and cohort size. MATERIALS AND METHODS We identified children <1 year of age with CHD who underwent abdominal surgery in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Project Pediatric database. Patients were stratified by surgical approach: open surgery (OS) versus LS. We then compared postoperative complications, postoperative length of stay, and 30-day mortality by using multivariable regression methods. RESULTS In total, 3684 patients met study criteria: 2502 underwent OS while 1182 underwent LS. Infants who underwent LS were older (98 days versus 36 days), larger by weight (4.2 kg versus 3.2 kg), and more likely to require nutritional support preoperatively (74.7% versus 60.5%) (all P < .001). After multivariable adjustment, LS was associated with lower overall complication rate (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.34-0.52, P < .001) and shorter postoperative length of stay (effect size -1.8 days, 95% CI -1.8-1.2, P < .001). LS and OS demonstrated similar 30-day mortality (OR 0.71, 95% CI 0.38-1.32, P = .28). CONCLUSIONS Laparoscopy can be performed safely in infants with CHD who need abdominal surgery. Although further studies may be useful in determining which infants with congenital cardiac disease benefit the most from use of laparoscopy, minimally invasive techniques can be applied to routine and complex abdominal procedures.
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Affiliation(s)
- Jina Kim
- 1 Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Zhifei Sun
- 1 Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Brian R Englum
- 1 Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Alexander C Allori
- 2 Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center , Durham, North Carolina
| | - Obinna O Adibe
- 3 Division of Pediatric Surgery, Duke University Medical Center , Durham, North Carolina
| | - Henry E Rice
- 3 Division of Pediatric Surgery, Duke University Medical Center , Durham, North Carolina
| | - Elisabeth T Tracy
- 3 Division of Pediatric Surgery, Duke University Medical Center , Durham, North Carolina
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11
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Dorsey D, Kwon S, Krieger E, Yeung RS, Natrajan K, Dembo G. Conflicting Hemodynamic Goals in an Adult Patient With Fontan Physiology Presenting for Resection of a Hepatocellular Carcinoma. J Cardiothorac Vasc Anesth 2016; 30:452-4. [DOI: 10.1053/j.jvca.2015.08.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Indexed: 11/11/2022]
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12
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Zach KJ, Ramakrishna H, Chandrasekaran K, Weis RA. Laparoscopic colectomy in an adult with single ventricle physiology: anesthetic implications and management. Ann Card Anaesth 2016; 18:252-6. [PMID: 25849703 PMCID: PMC4881640 DOI: 10.4103/0971-9784.154495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Increasing numbers of adult patients with complex congenital heart conditions are presenting for noncardiac surgery later in life. These disorders can present challenges for surgical and anesthesia providers. Specifically, single ventricle lesions offer anatomic and physiologic concerns during the perioperative period. Single ventricle physiology represents a delicate balance between systemic and pulmonary blood flow. Any alterations in blood flow through these systems can produce undesirable hemodynamic changes, especially during the perioperative period. We present a case of an adult patient with a single left ventricle who presented for laparoscopic total colectomy due to inflammatory bowel disease. His abnormal anatomy coupled with the hemodynamic disruptions caused by laparoscopy presented significant anesthetic challenges. We highlight the anesthetic concerns of single ventricle physiology, specifically pertaining to laparoscopic surgery. We provide recommendations for safely managing these patients perioperatively. With detailed preoperative evaluation and close hemodynamic monitoring during the perioperative period, these patients can experience successful surgical and anesthetic outcomes.
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Affiliation(s)
- Kelly J Zach
- Department of Anesthesia, Division of Cardiothoracic Anethesia, Mayo Clinic Hospital, Phoenix, AZ, USA
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13
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Sulkowski JP, Cooper JN, McConnell PI, Pasquali SK, Shah SS, Minneci PC, Deans KJ. Variability in noncardiac surgical procedures in children with congenital heart disease. J Pediatr Surg 2014; 49:1564-9. [PMID: 25475794 PMCID: PMC4259048 DOI: 10.1016/j.jpedsurg.2014.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this study was to examine the volume and variability of noncardiac surgeries performed in children with congenital heart disease (CHD) requiring cardiac surgery in the first year of life. METHODS Patients who underwent cardiac surgery by 1 year of age and had a minimum 5-year follow-up at 22 of the hospitals contributing to the Pediatric Health Information System database between 2004 and 2012 were included. Frequencies of noncardiac surgical procedures by age 5 years were determined and categorized by subspecialty. Patients were stratified according to their maximum RACHS-1 (Risk Adjustment in Congenital Heart Surgery) category. The proportions of patients across hospitals who had a noncardiac surgical procedure for each subspecialty were compared using logistic mixed effects models. RESULTS 8857 patients underwent congenital heart surgery during the first year of life, 3621 (41%) of whom had 13,894 noncardiac surgical procedures by 5 years. Over half of all procedures were in general surgery (4432; 31.9%) or otolaryngology (4002; 28.8%). There was significant variation among hospitals in the proportion of CHD patients having noncardiac surgical procedures. Compared to children in the low risk group (RACHS-1 categories 1-3), children in the high-risk group (categories 4-6) were more likely to have general, dental, orthopedic, and thoracic procedures. CONCLUSIONS Children with CHD requiring cardiac surgery frequently also undergo noncardiac surgical procedures; however, considerable variability in the frequency of these procedures exists across hospitals. This suggests a lack of uniformity in indications used for surgical intervention. Further research should aim to better standardize care for this complex patient population.
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Affiliation(s)
- Jason P. Sulkowski
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Jennifer N. Cooper
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Patrick I. McConnell
- Division of Cardiothoracic Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Sara K. Pasquali
- Division of Cardiology, Department of Pediatrics, University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, MI
| | - Samir S. Shah
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Peter C. Minneci
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Katherine J. Deans
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
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Knott EM, Fraser JD, Alemayahu H, Drake WB, St. Peter SD, Perryman KM, Juang D. Evaluation of Cardiac Function During Laparoscopic Gastrostomy in Pediatric Patients with Hypoplastic Left Heart Syndrome Using Intraoperative Transesophageal Echocardiography. J Laparoendosc Adv Surg Tech A 2014; 24:738-41. [DOI: 10.1089/lap.2014.0287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | - David Juang
- Children's Mercy Hospital, Kansas City, Missouri
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15
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Jooste EH, Haft WA, Ames WA, Sherman FS, Vallejo MC. Anesthetic care of parturients with single ventricle physiology. J Clin Anesth 2013; 25:417-423. [DOI: 10.1016/j.jclinane.2012.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 08/22/2012] [Accepted: 08/29/2012] [Indexed: 11/29/2022]
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Abstract
The considerable progress, performed for more than 30 years, in paediatric and interventional cardiology, imaging, surgery, anaesthesia and critical care in the congenital heart diseases allowed the survival the adulthood of more than 85 % of the affected children. The univentricular repair in total cavopulmonary connection or Fontan procedure, are realized in three stages, now, before the age of 5 years, with a different physiology after each stage. This point makes anaesthetic care more complicated for a non-cardiac surgery. The precise knowledge of the physiology of the "Fontan" is necessary before proceeding with anaesthesia. It allows to anticipate the pitfalls and to define specific strategies to be applied.
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Affiliation(s)
- P Mauriat
- Service d'anesthésie II, hôpital Haut-Lévèque, avenue de Magellan, 33604 Pessac cedex, France.
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17
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Menghraj SJ. Anaesthetic considerations in children with congenital heart disease undergoing non-cardiac surgery. Indian J Anaesth 2012; 56:491-5. [PMID: 23293389 PMCID: PMC3531005 DOI: 10.4103/0019-5049.103969] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The objective of this article is to provide an updated and comprehensive review on current perioperative anaesthetic management of paediatric patients with congenital heart disease (CHD) coming for non-cardiac surgery. Search of terms such as "anaesthetic management," "congenital heart disease" and "non-cardiac surgery" was carried out in KKH eLibrary, PubMed, Medline and Google, focussing on significant current randomised control trials, case reports, review articles and editorials. Issues on how to tailor perioperative anaesthetic management on cases with left to right shunt, right to left shunt and complex heart disease are discussed in this article. Furthermore, the author also highlights special considerations such as pulmonary hypertension, neonates with CHD coming for extracardiac surgery and the role of regional anaesthesia in children with CHD undergoing non-cardiac operation.
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Gillory LA, Megison ML, Harmon CM, Chen MK, Anderson S, Chong AJ, Chaignaud BE, Beierle EA. Laparoscopic surgery in children with congenital heart disease. J Pediatr Surg 2012; 47:1084-8. [PMID: 22703774 DOI: 10.1016/j.jpedsurg.2012.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The study aim was to determine outcomes of children with congenital heart disease who underwent laparoscopic procedures. METHODS A single-institution, institutional review board-approved, retrospective review was conducted including children younger than 5 years with congenital heart disease who underwent laparoscopic or open abdominal procedures. Patient demographics, operative details, complications, and 30-day mortality were examined. RESULTS Over 10 years, 111 children with congenital heart disease underwent 121 laparoscopic procedures. Median age was 2.5 months, with 87% being infants. Laparoscopic gastrostomy was the most common procedure (101). There was no intraoperative hemodynamic instability, median operative time was 70 minutes, postoperative complications were low (5%), and all children were alive at 30 days. Only 8 patients required conversion from laparoscopic to open, all secondary to technical issues, not hemodynamic instability. There were 42 children with cardiac disease who underwent 45 open procedures during the study period. There were no significant differences between patient demographics, type of procedure, operative time, complications, or 30-day mortality comparing the open and laparoscopic groups. CONCLUSION In this review, there were no major contraindications to performing laparoscopic procedures in children with congenital heart disease, and we conclude that it is reasonably safe to perform laparoscopic surgery on these children.
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19
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Anaesthetic and post-operative management of a modified Norwood operation for hypoplastic left heart syndrome: a retrospective series of 11 cases. Cardiol Young 2011; 21:321-7. [PMID: 21303587 DOI: 10.1017/s1047951111000011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to describe the pre-operative and operative findings, as well as the post-operative haemodynamics of patients operated on for hypoplastic left heart. The findings of patients who survived or did not survive were also compared to anticipate the risk factors for mortality. METHODS We retrospectively reviewed the anaesthetic and intensive care records of 11 (seven male and four female) patients who underwent a modified Norwood operation as neonates. There were eight patients who survived, while three did not survive after the operation. Haemodynamics, oxygenation, and medications of patients were recorded for the pre-operative and post-operative conditions for 2 days, and compared between groups of patients who survived and those who did not. RESULTS The normalised modified Blalock-Taussig shunt area was 3.28, 0.57 square millimetres per kilogram (mean, standard deviation) for the group of patients who survived and 3.55, 1.4 square millimetres per kilogram for the group of patients who did not survive (p = 0.51). The group of patients who survived had a significantly larger normalised aortic annulus area (3.3, 0.89 square millimetres per kilogram versus 1.68, 0.21 square millimetres per kilogram, p = 0.01), lower median age (5.57 (3-8) days versus 46.67 (4-90) days, p = 0.02), and lower weight (2.95, 0.46 kilograms versus 3.85, 0.56 kilograms, p = 0.03) than the group of patients who did not survive. Furthermore, the group of patients who did not survive had a significantly worse pre-operative condition, lower systemic venous and arterial oxygen saturation, and need for a high dose of drugs in the pre-operative and post-operative periods (p was less than 0.05 for each variable). CONCLUSION The pre-operative, operative, and post-operative findings may be related to mortality early after the modified Norwood operation for hypoplastic left heart syndrome.
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Eagle SS, Daves SM. The Adult With Fontan Physiology: Systematic Approach to Perioperative Management for Noncardiac Surgery. J Cardiothorac Vasc Anesth 2011; 25:320-34. [DOI: 10.1053/j.jvca.2010.12.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Indexed: 01/19/2023]
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Andritsos M, Singh N, Patel P, Sinha A, Fassl J, Wyckoff T, Riha H, Roscher C, Subramaniam B, Ramakrishna H, Augoustides JG. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2010. J Cardiothorac Vasc Anesth 2011; 25:6-15. [DOI: 10.1053/j.jvca.2010.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Indexed: 12/14/2022]
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