Anesthesia for major general surgery in neonates with complex cardiac defects

Abstract

Centers with large cardiac workloads may be presented with neonates who need major general surgery before correction or palliation of a serious cardiac defect. This is still a rare situation with only three short case reports available in the medical literature (1-3). We have reviewed the anesthetic and analgesic regimens of 18 such neonates who presented to the Birmingham Children's Hospital in the 4-year period 2004-2007. These children require meticulous preoperative evaluation and although it might be anticipated that they would pose a serious challenge to anesthetists, in reality with thorough investigation, preparation, and careful management, they tolerate general anesthesia well. These children may be transferred to centers of specialist pediatric cardiac anesthesia to be benefited from experience obtained there.

Anesthetic management of noncardiac surgery for patients with single ventricle physiology

“…However, some patients are required to have noncardiac surgeries even before cardiac intervention. Several case reports have described anesthetic management for these patients [22][23][24]. Noncardiac surgeries for this population occur mostly on emergent basis.…”

Anaesthetic Management of Tetralogy of Fallot Coming for Non-Cardiac Surgery: A Case Report

“…Opioid infusion for major operations has been the primary postoperative intervention for pain for these patients. [1,3] The use of regional anesthesia for well-compensated patients was reported with no complications. [2] [13] Even with favorable outcome, non-cardiac surgery still carries high-risk after operation.…”

“…Ketamine was the most common induction agent. [3] Inotropes should be continued and IV induction agents titrated. The need for invasive monitoring should depend on the type of surgery and cardiac lesion.…”

“…[2] [13] Even with favorable outcome, non-cardiac surgery still carries high-risk after operation. [3] Observing them in high-dependency bed or intensive care unit will warrant assurance of catching arrhythmia, cardiac ischaemia, dehydration, pain, ventilator issues and other complications before they cause detrimental effects.…”

Anesthetic management of tracheoesophageal fistula repair in a newborn with a double-outlet right ventricle

“…An even smaller number of patients with these associated abnormalities require surgical intervention prior to correction or palliation of the cardiac defect. Although multiple case reports and studies of major general surgery and CHD have been published, few involve patients with an unrepaired double-outlet right ventricle [2][3][4][5]. The anesthetic management of a neonate with a double-outlet right ventricle and associated tracheoesophageal fistula, who underwent repair of this fistula, is presented.…”