By Andropoulos, Dean B
This well timed revision displays the quick advances in surgical procedure and anesthesia for congenital center ailment that experience happened lately, together with neonatal cardiac surgical procedure and anesthesia, therapy of unmarried ventricle sufferers, new diagnostic modalities, and advancements within the catheterization laboratory. New chapters tackle mechanical aid of the flow, embryology, and quality/outcomes management.
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Additional resources for Anesthesia for congenital heart disease
Any decrease in PVR during anesthesia in a child with unrepaired truncus arteriosus can lead to pulmonary “steal” of systemic blood flow and decreased diastolic pressure through the common trunk to the aorta and PA, resulting in hypotension and 9 insufficient systemic blood flow expressed initially as coronary insufficiency and ST depression (or elevation). During the same decade, the surgical treatment of transposition of the great arteries (TGA) underwent several changes. The Mustard operations (as one type of atrial switch procedure) were feared because of the risk of SVC obstruction as a complication of this surgical procedure.
Fentanyl-air-oxygen anesthesia for ligation of patent ductus arteriosus in preterm infants. Anesth Analg 1981;60:331–4. This paper introduced the use of high-dose synthetic opioids in pediatric cardiac anesthesia. 15 28 Anand KJ, Sippell WG, Aynsley-Green A. Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery. Effects on the stress response. Lancet 1987;1(8527):243–8. This study shows that preterm babies undergoing ligation of PDAs can have a significant stress response affecting postoperative course and fentanyl administration can decrease the response and improve outcomes.
Typical mandatory exposure is 1–2 months with 20–30 CPB cases. The words “rarely” or “occasionally” were most commonly used by the individuals surveyed to describe the frequency with which adult cardiothoracic anesthesia fellows use available elective time to pursue training in pediatric cardiac anesthesia. Besides the three known 12-month pediatric cardiac anesthesia fellowships (two in the USA, one in the UK), there were several programs in the USA that offer additional training in pediatric cardiac anesthesia for intervals of 3–12 months on an ad hoc basis.