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Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care pp 743–757Cite as

Anesthetic Considerations for Children with Congenital Heart Disease Undergoing Non-cardiac Surgery

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Abstract

Children with congenital heart disease are at increased risk for adverse events during noncardiac surgery. It is essential that the anesthesiologists caring for these children have a comprehensive understanding of the underlying physiology and the impact this has on the delivery of anesthesia. Specific problems such as pulmonary hypertension, cyanosis, heart failure, pacemakers, and endocarditis prophylaxis are reviewed in this chapter. Specific anesthetic considerations for patients who have palliated single ventricle physiology or have received a heart transplant are also discussed.

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References

  1. White MC (2011) Approach to managing children with heart disease for noncardiac surgery. Paediatr Anaesth 21:522–529

    Article  PubMed  Google Scholar 

  2. Deanfield J, Thaulow E, Warnes C et al (2003) Management of grown up congenital heart disease. Eur Heart J 24:1035–1084

    Article  PubMed  Google Scholar 

  3. Baum VC, Barton DM, Gutgesell HP (2000) Influence of congenital heart disease on mortality after noncardiac surgery in hospitalized children. Pediatrics 105:332–335

    Article  CAS  PubMed  Google Scholar 

  4. Ramamoorthy C, Haberkern CM, Bhananker SM et al (2010) Anesthesia-related cardiac arrest in children with heart disease: data from the Pediatric Perioperative Cardiac Arrest (POCA) registry. Anesth Analg 110:1376–1382

    Article  CAS  PubMed  Google Scholar 

  5. Flick RP, Sprung J, Harrison TE, et al (2007) Perioperative cardiac arrests in children between 1988 and 2005 at a tertiary referral center: a study of 92,881 patients. Anesthesiology 106:226–237; quiz 413–414

    Article  PubMed  Google Scholar 

  6. Watkins SC, McNew BS, Donahue BS (2013) Risks of noncardiac operations and other procedures in children with complex congenital heart disease. Ann Thorac Surg 95:204–211

    Article  PubMed  Google Scholar 

  7. Walker A, Stokes M, Moriarty A (2009) Anesthesia for major general surgery in neonates with complex cardiac defects. Paediatr Anaesth 19:119–125

    Article  PubMed  Google Scholar 

  8. Steven JM (2010) Congenital heart disease and anesthesia-related cardiac arrest: connecting the dots. Anesth Analg 110:1255–1256

    Article  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. Sumpelmann R, Osthaus WA (2007) The pediatric cardiac patient presenting for noncardiac surgery. Curr Opin Anaesthesiol 20:216–220

    Article  PubMed  Google Scholar 

  11. Nef HM, Mollmann H, Hamm C et al (2010) Pulmonary hypertension: updated classification and management of pulmonary hypertension. Heart 96:552–559

    Article  CAS  PubMed  Google Scholar 

  12. Carmosino MJ, Friesen RH, Doran A et al (2007) Perioperative complications in children with pulmonary hypertension undergoing noncardiac surgery or cardiac catheterization. Anesth Analg 104:521–527

    Article  PubMed  PubMed Central  Google Scholar 

  13. Taylor CJ, Derrick G, McEwan A et al (2007) Risk of cardiac catheterization under anaesthesia in children with pulmonary hypertension. Br J Anaesth 98:657–661

    Article  CAS  PubMed  Google Scholar 

  14. Price LC, Wort SJ, Finney SJ et al (2010) Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review. Crit Care 14:R169

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rudolph AM, Yuan S (1966) Response of the pulmonary vasculature to hypoxia and H + ion concentration changes. J Clin Invest 45:399–411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. DeFilippis AP, Law K, Curtin S et al (2007) Blood is thicker than water: the management of hyperviscosity in adults with cyanotic heart disease. Cardiol Rev 15:31–34

    Article  PubMed  Google Scholar 

  17. Tempe DK, Virmani S (2002) Coagulation abnormalities in patients with cyanotic congenital heart disease. J Cardiothorac Vasc Anesth 16:752–765

    Article  PubMed  Google Scholar 

  18. Horigome H, Hiramatsu Y, Shigeta O et al (2002) Overproduction of platelet microparticles in cyanotic congenital heart disease with polycythemia. J Am Coll Cardiol 39:1072–1077

    Article  PubMed  Google Scholar 

  19. Oechslin E, Kiowski W, Schindler R et al (2005) Systemic endothelial dysfunction in adults with cyanotic congenital heart disease. Circulation 112:1106–1112

    Article  PubMed  Google Scholar 

  20. Cordina RL, Celermajer DS (2010) Chronic cyanosis and vascular function: implications for patients with cyanotic congenital heart disease. Cardiol Young 20:242–253

    Article  PubMed  Google Scholar 

  21. Ghorbel MT, Cherif M, Jenkins E et al (2010) Transcriptomic analysis of patients with tetralogy of Fallot reveals the effect of chronic hypoxia on myocardial gene expression. J Thorac Cardiovasc Surg 140:337–345 e26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Fletcher R (1991) The relationship between the arterial to end-tidal PCO2 difference and hemoglobin saturation in patients with congenital heart disease. Anesthesiology 75:210–216

    Article  CAS  PubMed  Google Scholar 

  23. Kantor PF, Redington AN (2010) Pathophysiology and management of heart failure in repaired congenital heart disease. Heart Fail Clin 6:497–506, ix

    Article  PubMed  Google Scholar 

  24. Rosenthal DN, Hammer GB (2011) Cardiomyopathy and heart failure in children: anesthetic implications. Paediatr Anaesth 21:577–584

    Article  PubMed  Google Scholar 

  25. Murat I, Constant I, Maud’huy H (2004) Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period. Paediatr Anaesth 14:158–166

    Article  PubMed  Google Scholar 

  26. Warner MA, Lunn RJ, O’Leary PW et al (1998) Outcomes of noncardiac surgical procedures in children and adults with congenital heart disease. Mayo Perioperative Outcomes Group. Mayo Clin Proc 73:728–734

    Article  CAS  PubMed  Google Scholar 

  27. Murphy TW, Smith JH, Ranger MR et al (2011) General anesthesia for children with severe heart failure. Pediatr Cardiol 32:139–144

    Article  PubMed  Google Scholar 

  28. Epstein AE, DiMarco JP, Ellenbogen KA et al (2008) ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 117:e350–e408

    Article  PubMed  Google Scholar 

  29. Navaratnam M, Dubin A (2011) Pediatric pacemakers and ICDs: how to optimize perioperative care. Paediatr Anaesth 21:512–521

    Article  PubMed  Google Scholar 

  30. Crossley GH, Poole JE, Rozner MA et al (2011) The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) expert consensus statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management: executive summary this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm 8:e1–e18

    Article  PubMed  Google Scholar 

  31. Stone ME, Salter B, Fischer A (2011) Perioperative management of patients with cardiac implantable electronic devices. Br J Anaesth 107(Suppl 1):i16–i26

    Article  PubMed  Google Scholar 

  32. American Society of A (2011) Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the American Society of Anesthesiologists Task Force on perioperative management of patients with cardiac implantable electronic devices. Anesthesiology 114:247–261

    Article  Google Scholar 

  33. Knirsch W, Nadal D (2011) Infective endocarditis in congenital heart disease. Eur J Pediatr 170:1111–1127

    Article  PubMed  Google Scholar 

  34. Wilson W, Taubert KA, Gewitz M et al (2007) Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 116:1736–1754

    Article  PubMed  Google Scholar 

  35. Pasquali SK, He X, Mohamad Z et al (2012) Trends in endocarditis hospitalizations at US children’s hospitals: impact of the 2007 American Heart Association antibiotic prophylaxis guidelines. Am Heart J 163:894–899

    Article  PubMed  PubMed Central  Google Scholar 

  36. Duval X, Delahaye F, Alla F et al (2012) Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol 59:1968–1976

    Article  PubMed  Google Scholar 

  37. Glenn WW, Gardner TH Jr, Talner NS et al (1968) Rational approach to the surgical management of tricuspid atresia. Circulation 37:II62–II67

    Article  CAS  PubMed  Google Scholar 

  38. Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26:240–248

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Norwood WI, Kirklin JK, Sanders SP (1980) Hypoplastic left heart syndrome: experience with palliative surgery. Am J Cardiol 45:87–91

    Article  CAS  PubMed  Google Scholar 

  40. Redington AN, Penny D, Shinebourne EA (1991) Pulmonary blood flow after total cavopulmonary shunt. Br Heart J 65:213–217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Christensen RE, Gholami AS, Reynolds PI et al (2012) Anaesthetic management and outcomes after noncardiac surgery in patients with hypoplastic left heart syndrome: a retrospective review. Eur J Anaesthesiol 29:425–430

    Article  CAS  PubMed  Google Scholar 

  42. Soliman DE, Maslow AD, Bokesch PM et al (1998) Transoesophageal echocardiography during scoliosis repair: comparison with CVP monitoring. Can J Anaesth 45:925–932

    Article  CAS  PubMed  Google Scholar 

  43. Neira VM, Gardin L, Ryan G et al (2011) A transesophageal echocardiography examination clarifies the cause of cardiovascular collapse during scoliosis surgery in a child. Can J Anaesth 58:451–455

    Article  PubMed  Google Scholar 

  44. Jenkins KJ, Gauvreau K, Newburger JW et al (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118

    Article  PubMed  Google Scholar 

  45. Slater B, Rangel S, Ramamoorthy C et al (2007) Outcomes after laparoscopic surgery in neonates with hypoplastic heart left heart syndrome. J Pediatr Surg 42:1118–1121

    Article  PubMed  Google Scholar 

  46. Torres A Jr, DiLiberti J, Pearl RH et al (2002) Noncardiac surgery in children with hypoplastic left heart syndrome. J Pediatr Surg 37:1399–1403

    Article  PubMed  Google Scholar 

  47. Davis D, Davis S, Cotman K et al (2008) Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatr Cardiol 29:328–333

    Article  CAS  PubMed  Google Scholar 

  48. Skinner ML, Halstead LA, Rubinstein CS et al (2005) Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg 130:1293–1301

    Article  PubMed  Google Scholar 

  49. Golbus JR, Wojcik BM, Charpie JR et al (2011) Feeding complications in hypoplastic left heart syndrome after the Norwood procedure: a systematic review of the literature. Pediatr Cardiol 32:539–552

    Article  PubMed  Google Scholar 

  50. Cheung YF, Ho MH, Cheng VY (2003) Mesenteric blood flow response to feeding after systemic-to-pulmonary arterial shunt palliation. Ann Thorac Surg 75:947–951

    Article  PubMed  Google Scholar 

  51. Wolovits JS, Torzone A (2012) Feeding and nutritional challenges in infants with single ventricle physiology. Curr Opin Pediatr 24:295–300

    Article  PubMed  Google Scholar 

  52. del Castillo SL, Moromisato DY, Dorey F et al (2006) Mesenteric blood flow velocities in the newborn with single-ventricle physiology: modified Blalock-Taussig shunt versus right ventricle-pulmonary artery conduit. Pediatr Crit Care Med 7:132–137

    Article  PubMed  Google Scholar 

  53. Mariano ER, Boltz MG, Albanese CT et al (2005) Anesthetic management of infants with palliated hypoplastic left heart syndrome undergoing laparoscopic nissen fundoplication. Anesth Analg 100:1631–1633

    Article  PubMed  Google Scholar 

  54. Garcia X, Jaquiss RD, Imamura M et al (2011) Preemptive gastrostomy tube placement after Norwood operation. J Pediatr 159:602–607 e1

    Article  PubMed  Google Scholar 

  55. Zahn EM, Chang AC, Aldousany A et al (1997) Emergent stent placement for acute Blalock-Taussig shunt obstruction after stage 1 Norwood surgery. Cathet Cardiovasc Diagn 42:191–194

    Article  CAS  PubMed  Google Scholar 

  56. Giglia TM, Humpl T (2010) Preoperative pulmonary hemodynamics and assessment of operability: is there a pulmonary vascular resistance that precludes cardiac operation? Pediatr Crit Care Med 11:S57–S69

    Article  PubMed  Google Scholar 

  57. Khanna G, Bhalla S, Krishnamurthy R et al (2012) Extracardiac complications of the Fontan circuit. Pediatr Radiol 42:233–241

    Article  PubMed  Google Scholar 

  58. Goldberg DJ, Dodds K, Rychik J (2010) Rare problems associated with the Fontan circulation. Cardiol Young 20(Suppl 3):113–119

    Article  PubMed  Google Scholar 

  59. Ghanayem NS, Berger S, Tweddell JS (2007) Medical management of the failing Fontan. Pediatr Cardiol 28:465–471

    Article  CAS  PubMed  Google Scholar 

  60. Madsen P, Shah SA, Rubin BK (2005) Plastic bronchitis: new insights and a classification scheme. Paediatr Respir Rev 6:292–300

    Article  PubMed  Google Scholar 

  61. Schure AY, Kussman BD (2011) Pediatric heart transplantation: demographics, outcomes, and anesthetic implications. Paediatr Anaesth 21:594–603

    Article  PubMed  Google Scholar 

  62. Blasco LM, Parameshwar J, Vuylsteke A (2009) Anaesthesia for noncardiac surgery in the heart transplant recipient. Curr Opin Anaesthesiol 22:109–113

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Children’s Hospital Colorado & University of Colorado Anschutz Medical Campus, 13123 East 16th Ave B090, Aurora, CO, 80045, USA

    Lawrence I. Schwartz, Richard J. Ing & Mark D. Twite

Authors
  1. Lawrence I. Schwartz
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  2. Richard J. Ing
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  3. Mark D. Twite
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Corresponding author

Correspondence to Lawrence I. Schwartz .

Editor information

Editors and Affiliations

  1. Dept. of Pediatric Cardiology, Children's Hospital Colorado, Univ. of Colorado, Denver, Aurora, Colorado, USA

    Eduardo M. Da Cruz

  2. Dept. Pediatric Cardiology, Children's Hospital Colorado, Univ. of Colorado, Denver, Aurora, Colorado, USA

    Dunbar Ivy

  3. Pediatric Cardiac Surgery, Children's Hospital Colorado, Univ. of Colorado, Denver, Aurora, Colorado, USA

    James Jaggers

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Schwartz, L.I., Ing, R.J., Twite, M.D. (2014). Anesthetic Considerations for Children with Congenital Heart Disease Undergoing Non-cardiac Surgery. In: Da Cruz, E., Ivy, D., Jaggers, J. (eds) Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-4619-3_200

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  • DOI: https://doi.org/10.1007/978-1-4471-4619-3_200

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4618-6

  • Online ISBN: 978-1-4471-4619-3

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