Outcomes following general anaesthesia in children with hypertrophic cardiomyopathy

Norrish, Gabrielle; Forshaw, Natalie; Woo, Colleen; Avanis, Mary Claire; Field, Ella; Cervi, Elena; Iguchi, Akane; Kaski, Juan Pablo

doi:10.1136/archdischild-2018-315366

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…The combination of hypotension and tachycardia is particularly threatening to subendocardial perfusion. 67,68 Dilated cardiomyopathy is often idiopathic but can be secondary to genetic disorders, infection, drugs, congenital HD, or other medical conditions. Dilated cardiomyopathy is characterized by ventricular dilation, impaired ventricular systolic function, loss of preload recruitable stroke work, and exaggerated depression of stroke volume in the setting of elevated afterload.…”

Section: Cardiomyopathymentioning

confidence: 99%

“…The combination of hypotension and tachycardia is particularly threatening to subendocardial perfusion. 67,68…”

Section: Perioperative Considerations For Specific High-risk Cardiac ...mentioning

confidence: 99%

“…However, many of these noncardiac conditions may be underappreciated or go unevaluated until symptoms that affect the patient's quality of life are reported. 68,69 Elective procedures allow time for additional evaluation of noncardiac systems to better define their severity and impact on the noncardiac surgery risk, whereas an emergency procedure may not allow sufficient time to fully investigate this multisystem involvement. Consequently, risk assessment based on available information may substantially underestimate the actual risk.…”

Section: Noncardiac Conditionsmentioning

confidence: 99%

See 2 more Smart Citations

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Nasr¹,

Markham²,

Clay³

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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Continuous advances in pediatric cardiology, surgery, and critical care have significantly improved survival rates for children and adults with congenital heart disease. Paradoxically, the resulting increase in longevity has expanded the prevalence of both repaired and unrepaired congenital heart disease and has escalated the need for diagnostic and interventional procedures. Because of this expansion in prevalence, anesthesiologists, pediatricians, and other health care professionals increasingly encounter patients with congenital heart disease or other pediatric cardiac diseases who are presenting for surgical treatment of unrelated, noncardiac disease. Patients with congenital heart disease are at high risk for mortality, complications, and reoperation after noncardiac procedures. Rigorous study of risk factors and outcomes has identified subsets of patients with minor, major, and severe congenital heart disease who may have higher-than-baseline risk when undergoing noncardiac procedures, and this has led to the development of risk prediction scores specific to this population. This scientific statement reviews contemporary data on risk from noncardiac procedures, focusing on pediatric patients with congenital heart disease and describing current knowledge on the subject. This scientific statement also addresses preoperative evaluation and testing, perioperative considerations, and postoperative care in this unique patient population and highlights relevant aspects of the pathophysiology of selected conditions that can influence perioperative care and patient management.

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Section: Cardiomyopathymentioning

confidence: 99%

“…The combination of hypotension and tachycardia is particularly threatening to subendocardial perfusion. 67,68…”

Section: Perioperative Considerations For Specific High-risk Cardiac ...mentioning

confidence: 99%

Section: Noncardiac Conditionsmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Nasr¹,

Markham²,

Clay³

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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“…7 It is still unknown what specific aspects of HCM may lead to pediatric mortality and complications, but peak LVOT gradients ≥30 mm Hg, intraoperative hypotension, and preexisting ventricular arrhythmias are considered strong identifiers demonstrated in the adult literature. 4 By using a combined spinal-caudal epidural technique, we aimed to minimize wide cardiac physiologic swings that would exacerbate the existing LVOTO. As supported in multiple pediatric studies, neuraxial anesthesia for pediatric patients allows for a stable hemodynamic profile where respiratory status, blood pressure, preload, and oxygen saturations do not change significantly from baseline, with a notable lower incidence of hypotension and need for intervention.…”

Section: Discussionmentioning

confidence: 99%

Use of a Spinal-Caudal Epidural Technique for Abdominal Surgery in a Newborn With Noonan Syndrome and Severe Hypertrophic Cardiomyopathy

et al. 2022

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Features of Noonan syndrome include a distinctive facial appearance, short stature, a broad or webbed neck, congenital heart disease, bleeding problems, skeletal malformations, and developmental delay. Although pulmonary stenosis is most commonly reported, up to 20% of patients have hypertrophic cardiomyopathy (HCM). We report the use of a combined spinal-caudal epidural anesthesia technique during urologic surgery (pyeloplasty) in an 8-week-old infant with Noonan syndrome and HCM. A spinal-caudal epidural technique provides favorable hemodynamic conditions, avoids the need for airway instrumentation, and may serve as an alternative to general anesthesia in these high risk patients.

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“…3 A recent study reported a low incidence of adverse events in children with hypertrophic cardiomyopathy (HOCM) undergoing general anesthesia. 4 This demonstrated the importance of expert centers in the management of complex cases. Specifically, the involvement of pediatric cardiac anesthetists in reducing adverse events in children having NCS.…”

Section: Ack N Owled G Em Entsmentioning

confidence: 97%

Pediatric perioperative cardiac arrest

Lewis

Barraclough

Nielsen

et al. 2021

Pediatric Anesthesia

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Pediatric perioperative mortality is an objective outcome measure of the safety of anesthesia and surgery. Information on pediatric perioperative cardiac arrest is limited in terms of incidence, risk factors, and outcome. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommends hospitals anesthetizing children to collect data on postoperative outcomes. 1 Anecdotally, heterogeneity exists between trusts in record keeping and finding data for reflective practice is challenging. Our APAGBI linkmen survey, "Clinical Capture of Paediatric Perioperative Morbidity and Mortality in the UK," found most respondents (n = 31; 54%) did not know where to access retrospective data on pediatric perioperative cardiac arrests.We developed an initiative to collect prospective data on pediatric perioperative CAs from May 2019 to March 2021. We involved multiple centers to increase case yield of a rare adverse event and expand learning.Twelve hospitals in London registered with local governance approval: 5 specialist pediatric centers and 7 nonspecialist.Perioperative cardiac arrest was defined as "cessation of adequate mechanical cardiac activity requiring CPR (+/-defibrillation) within 24 h of anesthesia." Demographic, comorbidity, anesthesia, cardiac arrest, and outcome data were collected. Patients ≤18 years were included.Critically ill patients having anesthesia for intensive care (ICU) management were excluded. This report contains complete datasets obtained from two institutions, 27 cardiac arrests in total. Incidence per institution was 0.04% and 0.08%. Table 1 shows demographic data and suspected etiology.Most were male patients (n = 19; 70%). Median age was 12 months (7 days -16 years), including 6 infants and 8 neonates (56%). Fourteen cases (52%) were ASA 4; the remainder were ASA 5 (n = 1; 3.7%), ASA 3 (n = 10; 37%), ASA 2 (n = 1; 3.6%), and ASA 1 (n = 1; 3.7%). Most cases were immediate or urgent (n = 16; 59%). Twenty-four cardiac arrests occurred in theater and three postoperatively.Cardiac cases represented 44% (n = 12): 6 in cardiac theater, 5 in the cardiac angiography suite, and 1 in ICU. The remaining cardiac arrests occurred in ENT (4), interventional radiology (IR) (3), general(3), urology (1), oral-maxillofacial (1), gastrointestinal (1), neurosurgical (1), and orthopedic theaters (1). Six were in cardiac patients having noncardiac surgery (NCS). The most common comorbidity was cardiac (n = 17; 63%): congenital heart disease n = 9, cardiomyopathy n = 6, heart block n = 1, and myocarditis n = 1. Other comorbidities were neuromuscular (spinal muscular atrophy and muscular dystrophy), airway (tracheal tumor, laryngeal cleft, and trachea-esophageal fistula), and respiratory (obstructive sleep apnea and asthma).The predominant cardiac arrest rhythm was pulseless electrical activity (PEA) (n = 24; 89%). Adrenaline was given in 23 (85%) cases as per the Advanced Paediatric Life Support (APLS) algorithm.Median cardiac arrest length was 3 min (45 s-18 min). Etiology was hypoxia or airway rela...

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Outcomes following general anaesthesia in children with hypertrophic cardiomyopathy

Cited by 7 publications

References 21 publications

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Use of a Spinal-Caudal Epidural Technique for Abdominal Surgery in a Newborn With Noonan Syndrome and Severe Hypertrophic Cardiomyopathy

Pediatric perioperative cardiac arrest

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