Abstract
Severe heart failure in children is uncommon. The anesthetic management of children with this condition is challenging. The authors aimed to identify the frequency with which anesthesia for short noncardiac surgical procedures or investigations was complicated by life-threatening hemodynamic instability and to describe the anesthetic techniques used. This study retrospectively reviewed the anesthetic charts and notes of children admitted acutely with a diagnosis of severe heart failure (fractional shortening of 15% or less) who received general anesthesia for noncardiac surgical or diagnostic interventions during the 3-year period from September 2005 to September 2008. In this study, 21 children received a total of 28 general anesthetics. Two patients (10%) experienced a cardiac arrest, and both required unplanned admission to the authors’ pediatric intensive care unit (PICU) postoperatively. A variety of anesthetic techniques was used. In 27 (96%) of the 28 cases, perioperative inotropic support was required. General anesthesia for children with severe heart failure is associated with a significant complication rate and should be administered by anesthetists familiar with managing all aspects of circulatory support for children in an appropriate setting.
Similar content being viewed by others
References
Andrews RE, Fenton MJ et al (2008) New-onset heart failure due to heart muscle disease in childhood: a prospective study in the United Kingdom and Ireland. Circulation 117:11–12
Andropoulos DA (2005) Anesthetic agents and their cardiovascular effects. In: Andropoulos DB, Stayer SA, Russell IA (eds) Anesthesia for congenital heart disease 2005. Blackwell Futura, Malden, MA, pp 49–63
Baum VC, Barton DM, Gutgessel HP (2000) Influence of congenital heart disease on mortality after noncardiac surgery in hospitalised children. Pediatrics 105:332–335
Friesen RH, Wurl JL, Charlton GA (2000) Haemodynamic depression by halothane is age-related in paediatric patients. Paediatr Anaesth 10:267–272
Geisslinger G, Hering W, Thomann P et al (1993) Pharmacokinetics and pharmacodynamics of ketamine enantiomers in surgical patients using a stereoselective analytical method. Br J Anaesth 70:666–671
Hennein HA, Mendeloff EN, Cilley RE et al (1994) Predictors of postoperative outcome after general surgical procedures in patients with congenital heart disease. J Pediatr Surg 29:866–870
Hickey PR, Hansen DD, Cramolini GM et al (1985) Pulmonary and systemic vascular hemodynamic responses to ketamine in infants with normal and elevated pulmonary vascular resistance. Anesthesiology 62:287–293
Department of Health (2010) Caldicott Guardian Manual 2010. Downloaded from www.dh.gov.uk/publications. Accessed 23 November 2010
Kipps AK, Ramamoorthy C, Rosenthal DN et al (2007) Children with cardiomyopathy: complications after noncardiac procedures with general anesthesia. Pediatr Anesth 17:775–781
Mayumi T, Dohi S, Takahashi T (1985) Cardiovascular effects of ketamine in humans with cervical or lumbar epidural blockade. Anesthesiology 62:39–43
Morray JP, Lynn AM, Stamm SJ et al (1984) Hemodynamic effects of ketamine in children with congenital heart disease. Anesth Analg 63:895–899
Murat I, Constant I, Maud’huy H (2004) Perioperative anesthetic morbidity in children: a database of 24, 165 anesthetics over a 30-month period. Paediatr Anaesth 14:158–166
Odegard KC, DiNardo JA, Kussman BD et al (2007) The frequency of anesthesia-related cardiac arrests in patients with congenital heart disease undergoing cardiac surgery. Anesth Analg 105:335–343
Pagel PS, Lowe D, Hettrick DA et al (1996) Isoflurane, but not halothane, improves indices of diastolic performance in dogs with rapid ventricular pacing induced cardiomyopathy. Anesthesiology 85:644–654
Rivenes SM, Lewin MB, Stayer SA et al (2001) Cardiovascular effects of sevoflurane, isoflurane, halothane, and fentanyl-midazolam in children with congenital heart disease: an echocardiographic study of myocardial contractility and hemodynamics. Anesthesiology 94:223–229
Russel IA, Miller Hance WC, Gregory G et al (2001) The safety and efficacy of sevoflurane anesthesia in infants and children with congenital heart disease. Anesth Analg 92:1152–1158
Schwartz GJ, Haycock GB, Edelmann CM Jr et al (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58(2):259–263
Stayer SA, Hammer GB (2005) Airway and ventilatory management. In: Andropoulos DB, Stayer SA, Russell IA (eds) Anesthesia for congenital heart disease 2005. Blackwell Futura, Malden, MA, pp 266–282
Torres A, DiLiberti J, Pearl RH et al (2002) Noncardiac surgery in children with hypoplastic left heart syndrome. J Pediatr Surg 37:1399–1403
Tortoriello TA (2006) Hemodynamic adaptive mechanisms in heart failure. In: Chang AC, Towbin JA (eds) Heart failure in children and young adults 2006. Saunders Elsevier, Philadelphia, PA, pp 60–84
White JM, Ryan CF (1996) Pharmacological properties of ketamine. Drug Alcohol Rev 15:145–155
Williams GD, Philip BM, Chu LF et al (2007) Ketamine does not increase pulmonary vascular resistance in children with pulmonary hypertension undergoing sevoflurane anesthesia and spontaneous ventilation. Anesth Analg 105:1578–1584
Acknowledgment
We acknowledge the support and helpful comments on our manuscript provided by Mr. Massimo Griselli and Drs. Milind Chaudhari and David Crossland.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Murphy, T.W.G., Smith, J.H., Ranger, M.R.B. et al. General Anesthesia for Children With Severe Heart Failure. Pediatr Cardiol 32, 139–144 (2011). https://doi.org/10.1007/s00246-010-9832-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-010-9832-4