Background: Glenn procedure is a Palliative surgical procedure performed as a step of staged repair for patients with single ventricle such as tricuspid atresia and hypoplastic left heart syndrome. It is usually performed at about three to six months of age, directs systemic venous blood directly from the superior vena cava to the pulmonary circulation. A significant burn injury affects almost all organs. Understanding the complex and pathophysiological responses in the early and late phases of injury is imperative to provide care in the acute and perioperative period. Large airway and lung edema can occur rapidly and unpredictably after burn. Hemodynamics changes in the early phase of severe burn injury are characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Case Summary: We report the management of a single ventricle patient with its challenges and unique consideration and major burn with its problems. She underwent serial debridement, extensive skin grafting to all burn areas. The patient had hemoglobin of 8.7 g/dl, she was on dopamine infusion to maintain blood pressure which was difficult to measure by BP cuff, the extremities were not an option to use as monitoring sites. Upon arrival, her oxygen saturation (SpO2) was being monitored with a disposable pulse oximetry sensor through the ear lobule, at times monitoring was disrupted and disappeared. We managed to use an oral airway to measure oxygen saturation through soft palate successfully and after transfusion we could wean off inotropic support. Conclusion: Patients with Glenn shunt whose acceptable oxygen saturation is 75-80% need hemoglobin level above 13 g/dl. Measurements of capillary density using reflectance oximetry through the soft palate provide very reliable SpO2 measurements.

Background and aim of the work: Pediatric cardiac patients often undergo non-cardiac surgical procedures and many of these patients would require intensive care unit admission, but can we predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Numerous preoperative and intraoperative variables were strongly associated with ICU admission. Given the variations in the underlying cardiac physiology and the diversity of noncardiac surgical procedures along with the scarce predictive clinical tools, we aimed to develop a simple and practical tool to predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Material and methods This is a retrospective study, where all files of pediatric cardiac patients who underwent noncardiac surgical procedures from January 1, 2015, to December 31, 2019, were reviewed. We retrieved details of the preoperative and intraoperative variables including age, weight, comorbid conditions, and underlying cardiac physiology. The primary outcome was the need for ICU admission. We performed multiple logistic regression analyses and analyses of the area under receiver operating characteristics (ROC) curves to develop a predictive tool. Results In total, 519 patients were included. The mean age and weight were 4.6 ± 3.4 year and 16 ± 13 Kg respectively. A small proportion (n = 90, 17%) required ICU admission. Statistically, there was strong association between each of American society of anesthesiologist’s physical status (ASA-PS) class III and IV, difficult intubation, operative time more than 2 hours, requirement of transfusion and the failure of a deliberately planned extubation and ICU admission. Additional analysis was done to develop a Cardiac Anesthesia Tool (CAT) based on the weight of each variable derived from the regression coefficient. The CAT list is composed of the ASA-PS, operative time, and requirement of transfusion, difficult intubation and the failure of deliberately planned extubation. The minimum score is zero and the maximum is eight. The probability of ICU admission is proportional to the score. Conclusion CAT is a practical and simple clinical tool to predict the need for ICU admission based on simple additive score. We propose using this tool for pediatric cardiac patients undergoing non-cardiac procedure.

Single ventricle is a complex cardiac disease which carry high morbidity and mortality and the average 3 years survival rate without Fontan procedure was approximated to be 75%. The most common etiologies are: hypoplastic left heart syndrome and tricuspid atresia. When those patient plan to go for surgery, it’s very essential for anesthetist to understand how the physiology is affected rather than etiology. BT shunt patency, right ventricular function and pulmonary artery pressure should be evaluated before any procedure under anesthesia. Scoliosis corrective surgery is a procedure that has its special considerations related to restrictive pulmonary disease, prone positioning, and major bleeding that may occur, which altogether will add to the risk when being conducted in a single-ventricle patient and will necessitate vigilance and special care during monitoring intraoperatively. Here, we report a simple way to monitor the transpulmonary pressure gradient through two central lines in the femoral and jugular veins as part of the patient’s anesthesia management.