Abstract
There is little clinical data in the literature on the anaesthetic management of paediatric patients with Eisenmenger’s syndrome undergoing non-cardiac surgery. This paper reviews our experiences with eight such patients who underwent a total of 11 surgical procedures. Of the eight children, six had Down’s syndrome and an atrio-ventricular septal defect, one had a ventricular septal defect and one an atrial septal defect. Nine of the eleven operations consisted of minor dental, plastic or ENT procedures, while one patient underwent two laparotomies. Premedication (trimeprazine/meperidine combination or midazolam) was administered on three occasions. Induction of anaesthesia was achieved by either inhalation of halothane (2), or intravenously with thiopentone (6), ketamine (2) or propofol (1). Muscle relaxation and mechanical ventilation were employed only for both intra-abdominal procedures, otherwise patients were allowed to breathe spontaneously with, or without, manual assistance. Halothane (8), isoflurane (2) and enflurane (1) were all used for maintenance of anaesthesia. Non-invasive monitoring was applied intraoperatively for minor procedures, and arterial and central venous catheters inserted for the laparotomies. Postoperative analgesia for both these cases was provided by an epidural infusion of bupivacaine 0.125% and fentanyl 5 μg · ml− 1. A single im bolus of morphine was required following a dental clearance, otherwise pain relief for the rest of the cases was achieved by local anaesthetic infiltration and NSAIDS. With the exception of a single episode of bradycardia, induction, maintenance and recovery from anaesthesia were well tolerated in all cases. In conclusion, our experience suggests that despite theoretical risks, children with Eisenmenger’s syndrome appear to tolerate a variety of anaesthetic techniques.
Résumé
Nous possédons peu de renseignements cliniques sur la gestion anesthésique d’enfants souffrant du syndrome d’Eisenmenger soumis à une chirurgie non cardiaque. Cet article décrit l’expérience des auteurs qui ont anesthésié huit de ces patients pour onze interventions. De ces huit enfants, six avaient un syndrome de Down et une communication auriculoventriculaire, un avait une communication interventriculaire et le dernier, une communication interauriculaire. Neuf des onze interventions étaient des interventions mineures dentaires, plastiques ou ORL, alors qu’un patient a subi deux laparotomies. On a administré à trois occasions une prémédication (triméprazine/mépéridine ou midazolam). L’induction a été réalisée avec soit de l’halothane (2) en inhalation, soit par la voie intraveineuse avec du thiopentone (6), de la kétamine (2) ou du propofol (1). La relaxation musculaire et la ventilation mécanique n’ont été utilisées que pour la chirurgie intraabdominale. Les autres patients ont respiré spontanément avec ou sans assistance manuelle. L’anesthésie a toujours été entretenue avec de l’halothane (8), de l’isqflurane (2) ou de l’enflurane (1). Pendant les interventions mineures, le monitorage a été non effractif alors que, pour les laparotomies, une canule artérielle et une tension veineuse centrale ont été insérées. Après ces deux interventions l’analgésie postopératoire a été obtenue avec une perfusion épidurale de bupivacaïne 0,125% et de fentanyl 5 μg ml− 1. Un seule injection de morphine a été requise après une extraction dentaire complète; pour les autres, l’analgésie a été procurée par infiltration d’un anesthésique local et des AINS. A part un épisode isolé de bradycardie, l’induction, le maintien et la récupération ont été bien tolérés. Les auteurs concluent que leur expérience démontre que malgré certains risques théoretiques, les enfants porteurs du syndrome d’Eisenmenger semblent bien tolérer des techniques anesthésiques variées.
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Lyons, B., Motherway, C., Casey, W. et al. The anaesthetic management of the child with Eisenmenger’s syndrome. Can J Anaesth 42, 904–909 (1995). https://doi.org/10.1007/BF03011038
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DOI: https://doi.org/10.1007/BF03011038