Incidence and Risk Factors for Perioperative Cardiovascular and Respiratory Adverse Events in Pediatric Patients With Congenital Heart Disease Undergoing Noncardiac Procedures

Lee, Sandra; Reddington, Elise; Koutsogiannaki, Sophia; Hernandez, Michael R.; Odegard, Kirsten C.; DiNardo, James A.; Yuki, Koichi

doi:10.1213/ane.0000000000003406

Cited by 23 publications

(20 citation statements)

References 15 publications

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“…Non-cardiac surgery included otolaryngology, maxillofacial, gastroenterology and general surgical procedures. The more severe the CHD, the higher the risks of reintubation and mortality [ 30 ].…”

Section: Preoperative Risk Assessment and Stratificationmentioning

confidence: 99%

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Egbuta

Mason

2020

JCM

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There have been significant advancements in the safe delivery of anesthesia as well as improvements in surgical technique; however, the perioperative period can still be high risk for the pediatric patient. Perioperative respiratory complications (PRCs) are some of the most common critical events that can occur in pediatric surgical patients and they can lead to increased length of hospitalization, worsened patient outcomes, and higher hospital and postoperative costs. It is important to determine the various factors that put pediatric patients at increased risk of PRCs. This will allow for more detailed and accurate informed consent, optimized perioperative management strategy, improved allocation of clinical resources, and, hopefully, better patient experience. There are only a few risk prediction models/scoring tools developed for and validated in the pediatric patient population, but they have been useful in helping identify the key factors associated with a high likelihood of developing PRCs. Some of these factors are patient factors, while others are procedure-related factors. Some of these factors may be modified such that the patient’s clinical status is optimized preoperatively to decrease the risk of PRCs occurring perioperatively. Fore knowledge of the factors that are not able to be modified can help guide allocation of perioperative clinical resources such that the negative impact of these non-modifiable factors is buffered. Additional training in pediatric anesthesia or focused expertise in pediatric airway management, vascular access and management of massive hemorrhage should be considered for the perioperative management of the less than 3 age group. Intraoperative ventilation strategy plays a key role in determining respiratory outcomes for both adult and pediatric surgical patients. Key components of lung protective mechanical ventilation strategy such as low tidal volume and moderate PEEP used in the management of acute respiratory distress syndrome (ARDS) in pediatric intensive care units have been adopted in pediatric operating rooms. Adequate post-operative analgesia that balances pain control with appropriate mental status and respiratory drive is important in reducing PRCs.

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Section: Preoperative Risk Assessment and Stratificationmentioning

confidence: 99%

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Egbuta

Mason

2020

JCM

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“…4 Similarly, in a large single-center cohort study, Lee et al demonstrated an 11.5% incidence of cardiovascular events and a 4.7% incidence of respiratory complications perioperatively. 5 Hence, proper diagnosis and anticipation of the challenges posed by airway abnormalities in CHD patients is crucial in reducing perioperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

Airway Abnormalities in Patients With Congenital Heart Disease: Incidence and Associated Factors

Foz

Peyton

Staffa

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…Respiratory events were associated with an ASA status of 4 or higher, and otolaryngology, gastrointestinal, general surgery, and maxillofacial procedures. They found that the incidence of cardiac events was higher than respiratory events, and though cardiovascular events were associated with cardiovascular status, respiratory events were not [29]. Institutions should consider the need for and availability of specialty trained pediatric cardiac anesthesiologists for complex congenital heart disease patients.…”

Section: Cardiovascular Eventsmentioning

confidence: 99%

Hot Topics in Safety for Pediatric Anesthesia

et al. 2020

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Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia and efforts to ameliorate risk. Conclusions: Pediatric anesthesiology has made great strides in patient perioperative safety with initiatives including the creation of a specialty society, quality and safety committees, large multi-institutional research efforts, and quality improvement initiatives. Common pediatric peri-operative events are now monitored with multi-institution and organization collaborative efforts, such as Wake Up Safe.

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Incidence and Risk Factors for Perioperative Cardiovascular and Respiratory Adverse Events in Pediatric Patients With Congenital Heart Disease Undergoing Noncardiac Procedures

Abstract: Intraoperative cardiovascular events and respiratory events in patients with CHD were relatively common. While cardiovascular events were highly associated with cardiovascular status, respiratory events were not associated with cardiovascular status.

Cited by 23 publications

References 15 publications

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Airway Abnormalities in Patients With Congenital Heart Disease: Incidence and Associated Factors

Hot Topics in Safety for Pediatric Anesthesia

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