Congenital Heart Disease in Pediatric and Adult Patients: Anesthetic and Perioperative Management

Description:

Congenital Heart Disease in Pediatric and Adult Patients: Anesthetic and Perioperative Management provides a comprehensive, up-to-date overview of care of the pediatric patient undergoing cardiac surgery and anesthesia. After introductory chapters that encompass pediatric cardiovascular embryology, physiology and pharmacology, diagnostic approaches and preoperative considerations are explained. The intraoperative management of a wide range of specific lesions is then discussed, with full descriptions of anesthesia plans added with descriptions on diagnostic methods and surgical interventions. Postoperative care is also addressed, and a concluding section considers anesthesia outside the cardiac operating room. In the twenty-first century, advances in minimally invasive technology have led to the introduction of a wide array of pediatric cardiac procedures. More traditional surgical procedures have also been transformed by new devices and surgical approaches. The cardiac anesthesiologist is faced with an ever-increasing role in the perioperative care of pediatric patients undergoing cardiologic procedures in operating rooms, as well as less conventional locations. In this book, accomplished experts from around the world in the fields of pediatric anesthesia, cardiology, and cardiac surgery describe the multiple facets of caring for this very unique patient population.

 

Table of contents:

Contributors

Part I: History, Embryology, Physiology and Pharmacology

Chapter 1: History of Pediatric Anesthesia and Pediatric Cardiac-Congenital Surgery

The Birth of Pediatrics and “Children’s Hospitals” in the United States

Surgical Pioneers in Pediatric Surgery

Origins of Pediatric Anesthesiology

Developments Leading to Pediatric Heart and Congenital Surgery

Future Directions

Chapter 2: Cardiovascular System Embryology and Development

Establishing Cardiac Crescent

Formation of the Heart Tube

The Looping of Cardiac Tissue

The Formation of the Sinus Venosus

The Next Steps in Differentiation: Atrial Development

The Primordial Heart Septation

Atrioventricular Valves

Septum Development in the Truncus Arteriosus and Conus Cordis

Semilunar Valve Formation

Development of the Cardiac Conducting System in the Heart

Atrioventricular (AV) Valve Anomalies

Stenosis of Cardiac Semilunar Valves

Cardiac Outflow Tract Septation Anomalies

Vascular Formation

Arterial System

Development of Aortic Arches

Development of Arterial Tree from Aortic Arches

Fate of the Vitelline and Umbilical Arteries

Dorsal Aorta Gives Rise to Lateral Branches

Intersegmental Branches

Formation of Limb Arteries

The Formation of Coronary Arteries

The Formation of Venous System

The Formation of Lymphatic System

Development of Lymph Sacs and Lymphatic Ducts

The Development of Thoracic Duct

Circulation Before and After Birth

Fetal Circulation

Circulatory Alterations After Birth

Angiomas

Abnormalities of the Ductus Arteriosus

Aortic Coarctation

Vena Cava Anomalies

IVC Anomalies

SVC Anomalies

Left Superior Vena Cava

Lymphatic System Anomalies

References

Chapter 3: Pediatric Cardiovascular Physiology

Evolutional Transition in Cardiac Physiology

Fetal Circulation

Changes in Circulation at Birth

Myocardial Electromechanical Function

Electrical Function of the Myocardium: Action Potential

Action Potential in Cardiac Cells

Cardiac Automaticity and Its Mechanism(s)

Excitation-Contraction Coupling: ECC

Calcium Homeostasis

Functioning Organelles of ECC

ECC-Modulating Mechanisms

Mechanical (Contractile) Function of the Myocardium

Thick Filament

Thin Filament

Z Disc, I Band, A Band, and M Line

Novel Therapeutic Agents Against Heart Failure

Control Mechanisms of Cardiac Function

Autonomic Control of the Heart

Sympathetic and Parasympathetic Receptors

Functions of the ANS in the Heart

Inotropic Effects of the β1- and M2 Receptor Activation

Chronotropic Effects of the β1- and M2 Receptor Activation

Lusitropic Effects of the β1-Receptor Activation

Developmental Changes in Fetal Cardiac Contractile System

Developmental Changes in Cardiac Ca2+ Homeostasis

Developmental Changes in Cardiac Action Potential

Developmental Changes in Mechanical Force Production and Contractile Function

Developmental Changes in Myocardial Function

Cardiac Cycle and Cardiac Work

Normal Cardiac Cycle

Cardiac Work

Frank-Starling Relationship

Cardiac Reflexes

Baroreceptor Reflex (or Carotid Sinus Reflex)

Bainbridge Reflex

Bezold-Jarisch Reflex

Chemoreceptor Reflex

Valsalva Maneuver

Neural Pathway

Cushing Reflex

Neural Pathway

Oculocardiac Reflex

References

Chapter 4: Cardiovascular Pharmacology in Pediatric Patients with Congenital Heart Disease

Vasoactive Agents

Pure Vasopressors (Pure Vasoconstrictors)

Phenylephrine

Common Adverse Effect of Phenylephrine

Vasopressin

Inoconstrictors

Epinephrine

Epinephrine Dose in Pediatric Cardiac Surgery

Dopamine

Clinical Effects of Dopamine

Norepinephrine

Inodilators (Mainly Milrinone, Dobutamine, and Levosimendan)

Milrinone

Dobutamine

Levosimendan

Pure Vasodilators

Nitroglycerin

Hydralazine

Alprostadil

Sodium Nitroprusside

Phentolamine Mesylate (Regitine)

Drugs Used in Pulmonary Hypertension

Nitric Oxide

Sildenafil

Endothelin Receptor Blockers (ET Blockers)

Drugs for Pediatric Delirium

Stress Ulcer Prevention and Treatment

Anticoagulation and Thrombolysis Drugs

Oral Anticoagulants

Antiplatelet Agents

Antifibrinolytic Agents

Antibiotic Prophylaxis in Perioperative Period

References

Part II: Diagnostics and Monitoring

Chapter 5: Perioperative Care of the Congenital Cardiac Patient in the Cardiac Catheterization L

Introduction

The Cath Lab Environment

The Goals of Congenital Cardiac Catheterization

Procedural Vascular Access and the Approach

Anesthetic Considerations in Diagnostic and Interventional Cardiac Cath Procedures

Preoperative Assessment

Intraoperative Management

Anesthetic Agents Used in Congenital Cardiac Catheterization

Volatile Anesthetic Agents

Propofol

Opiate Medications

Benzodiazepines

Ketamine

Dexmedetomidine

Complications in the Congenital Cath Lab

Hybrid Procedures

Conclusion

Bibliography

Chapter 6: Perioperative Imaging

Catheterization Laboratory

Intracardiac Echocardiography

Transthoracic Echocardiography

Transesophageal Echocardiography

Operating Room

Transesophageal Echocardiography Safety and Complications

Contraindications to Transesophageal Echocardiography

Relative and Absolute Contraindications to TEE

Relative Contraindications to TEE

Absolute Contraindications to TEE

Epicardial Echocardiography

Conclusion

References

Chapter 7: Pediatric Cardiovascular Monitoring

Noninvasive Monitoring

Pulse Oximetry

5-Lead Electrocardiogram

Blood Pressure

Near-Infrared Spectroscopy Monitors

Invasive Monitoring

Arterial Line

Central Venous Lines

Pulmonary Artery Catheter

Minimally Invasive Cardiac Output Monitors

Pulse Contour Analysis

Ultrasound

Bioimpedance/Bioreactance

References

Chapter 8: Electrocardiography: Basic Knowledge with Focus on Fetal and Pediatric ECG

Heart Rate

Rhythm

QRS Axis

Conduction Intervals

PR Interval

QT Interval

Morphology

P Wave

QRS Complex

T Wave

ST Segment

Chamber Hypertrophy

Right Ventricular Hypertrophy

Left Ventricular Hypertrophy

Biventricular Hypertrophy

Conduction Abnormalities

Atrioventricular Block

Intraventricular Conduction Defect

Right Bundle Branch Block

Left Bundle Branch Block

Left Fascicular Block

Multifascicular Block

Cardiac Tachyarrhythmias

Supraventricular Tachycardias

Ventricular Tachycardias

Congenital Heart Disease

Atrial Septal Defect

Ventricular Septal Defect

Atrioventricular Septal Defect

Patent Ductus Arteriosus

Truncus Arteriosus

Partially and Totally Anomalous Pulmonary Venous Returns

Tricuspid Atresia

Pulmonary Valve Stenosis and Pulmonary Valve Atresia

Tetralogy of Fallot

Ebstein Anomaly

Aortic Valve Stenosis

Coarctation of Aorta

Transposition of the Great Arteries

Congenitally Corrected Transposition of the Great Arteries

Cardiomyopathy

Hypertrophic Cardiomyopathy

Dilated Cardiomyopathy

Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Restrictive Cardiomyopathy

Dystrophies

Duchenne Muscular Dystrophy

Myotonic Muscular Dystrophy

Inflammatory Conditions

Kawasaki Disease

Pericarditis

Myocarditis

Acute Rheumatic Fever

Cardiac Tumors

Rhabdomyoma

Fibroma

Myxoma

References

Chapter 9: Central Nervous System Monitoring in Pediatric Cardiac Surgery

Introduction: The Role of CNS Monitoring in Pediatric Cardiac Surgery

Clinical Assessment of Pain and Sedation in Postoperative Period in Children

Assessment of Pain

The Children’s Hospital of Eastern Ontario Pain Scale: CHEOPS

Face, Legs, Activity, Cry, Consolability Scale (FLACC)

COMFORT Scale

Toddler Preschool Postoperative Pain Scale (TPPPS)

Parents’ Postoperative Pain Measure (PPPM)

Assessment of Sedation

Ramsay Sedation Scale (Ramsay)

Richmond Agitation Sedation Scale (RASS)

Sedation Agitation Scale (SAS)

Near Infrared Spectroscopy (NIRS)

Electroencephalography (EEG) Including Traditional EEG, qEEG, and CCEEG

History of EEG

What Are the Applications of EEG in the Perioperative Period?

How EEG Works (Including 10/20 System and the Waves)

Interpretation of EEG

How to Report EEG

Limitations of EEG

EEG Considerations in Pediatric and Neonatal Group

Amplitude Integrated EEG: aEEG

Transcranial Doppler: TCD

Windows for TCD Signal Acquisition

What Are the Main Limitations of TCD?

Jugular Venous Oxygen Saturation (SjVO2)

What Does SjVO2 Monitoring Show Us?

SjVO2 Catheters and the Technique Used for Their Insertion

Anatomic Approach

Limitations of Data Interpretation for SjVO2 and Methods to Correct It

Depth of Anesthesia and Sedation

Evoked Potentials: Somatosensory Evoked Potential (SSEP), Motor Evoked Potential (MEP), Auditory Ev

References

Chapter 10: Respiratory Monitoring

Introduction

Clinical Assessment

Inspection

Work of Breathing (WOB)

Nasal Flaring

Recession

Accessory Muscle Use

Skin Color

Auscultation

Respiratory Sounds

Normal Breath Sounds

Adventitious or Abnormal Sounds

Palpation

Percussion

Cardiopulmonary Interactions

Respiratory Monitoring Adjuncts

Pulse Oximetry

Capnography and Capnometry

References

Chapter 11: Coagulation Monitoring

Introduction

Pediatric Hemostasis

Comparison Between Neonatal and Adult Hemostasis

Congenital Heart Disease and Coagulation

Clinical Evaluation and Preoperative Laboratory Testing

Coagulopathy and Cardiac Bypass

Monitoring of Coagulation

Laboratory-Based Coagulation Test

Point-of-Care Monitoring

Thromboelastography (TEG®) and Thromboelastometry (ROTEM®)

History and Nomenclature

Operation Principles

Graph Analysis and Parameters

Types of Testing

Result Interpretation

Indications and Limitations of Thromboelastography and Thromboelastometry

Platelet Function Testing

Monitoring Integration in Clinical Care

References

Part III: Preoperative Considerations

Chapter 12: Preoperative Evaluation

Introduction

Medical History

Physical Examination

Para Clinical Diagnostic Tests

Chest Radiography

Electrocardiography

Echocardiography

Computerized Tomography

Cardiac Magnetic Resonance Imaging (cMRI)

Cardiac Catheterization and Angiography

Conclusion

References

Chapter 13: Anesthetic Management of Adults with Congenital Heart Disease

Epidemiology of Adult Congenital Heart Disease

Major Categories of Congenital Cardiac Structural Defects

Shunt Lesions

Mixing Lesions

Obstructive Lesions

Regurgitant Lesions

Acyanotic Congenital Heart Disease

Dextrocardia

Congenitally Corrected Transposition of the Great Vessels

Congenitally Bicuspid Aortic Valve

Coarctation of the Aorta

Pulmonic Stenosis

Primary Pulmonary Hypertension and Pulmonary Vascular Disease

Left-to-Right Shunt Lesions

Patent Ductus Arteriosus

Atrial Septal Defects

Ventricular Septal Defects

Cyanotic Congenital Heart Disease

Tetralogy of Fallot

Ebstein’s Anomaly

Transposition of the Great Arteries

Eisenmenger Syndrome

Single-Ventricle Physiology and Complex Cyanotic Congenital Heart Disease

Perioperative Concerns and Anesthetic Management

Syndromes and Associated Anomalies

Perioperative Monitoring

Airway and Ventilatory Management

Intravenous Access Considerations

Perioperative Fluid Management and NPO Intervals

Hematocrit and Perioperative Transfusion Management

Antibiotic Prophylaxis

Pacemakers and Arrhythmias

Postoperative Considerations

Conclusion

Case Study: Anesthetic Management of a Hybrid Approach to Transcatheter Pulmonary Valve Replacem

Bibliography

Chapter 14: Medical Facility Infrastructure Considerations

Identification of Pediatric Patients and Referral Management

Evaluation Coordination

Surgical and Cardiologic Interventional Issues

References

Part IV: Intraoperative Care Including Management of Specific Pathologies

Chapter 15: Limiting the Lifetime Surgical Impact of Congenital Heart Disease and Guiding Care fo

Limiting the Lifetime Surgical Impact of Congenital Heart Disease and Guiding Care for the Con

Transcatheter Palliation

Transcatheter Occlusion of Patent Ductus Arteriosus in Premature Infants

Transcatheter Valves

Electrophysiologic Devices

Blood Conservation/Bloodless Cardiac Surgery

Pain Management

Radiation Issues

Neurodevelopmental Issues

Psychological Stressors

Child Life Counseling/Psychological Assessment

Conclusion

References

Chapter 16: Cardiopulmonary Bypass in Children and Infants

Introduction

Components of CPB

Vascular Access

Tubing

Blood Pumps

Oxygenator

Priming and Hemodilution

Metabolism During CPB

Systemic Inflammation During CPB

Controlling the Host Response

Conclusions

References

Chapter 17: Atrioventricular Septal Defect (AVSD)

Introduction

Cardiac Anatomy and Embryology

Pathologic Findings and Associated Anomalies

Classification of AVSD

Associated Cardiac Anomalies

Clinical Presentation and Diagnosis of the Disease

Echocardiography

Surgical Repair

Intraoperative Management of Anesthesia

Postoperative Care for AVSD

Reoperation

Outcome

References

Chapter 18: Atrial Septal Defect and Ventricular Septal Defect

Atrial Septal Defect

Introduction

Embryology

Classification

Pathophysiology of ASD

Diagnosis of ASD

Clinical Diagnosis of ASD

Electrocardiography

CXR

Imaging Techniques in Diagnosis of ASD

Echocardiography

Other Imaging Studies

Treatment

Anesthesia for ASD Treatment

Ventricular Septal Defect

Introduction

Embryology and Classification of VSD

Pathophysiology

Diagnosis

General Findings

Respiratory Findings

Cardiovascular Findings

Treatment

Anesthetic Management

Outcome

References

Chapter 19: Tetralogy of Fallot

Introduction

Case Presentation

Embryology and Anatomy

Uncomplicated TOF

Presentation and Anatomic Correlation

Historical Therapeutic Approaches and Outcomes

Contemporary Surgical Management and Outcomes

Timing of Surgery

Surgical Technique

Natural History of Operative Correction

Comorbidities

Anesthesia Considerations

Anatomic Variants of TOF

PDA-Dependent Lesions

Pulmonary Atresia and Critical Pulmonary Stenosis

Non-PDA-Dependent Lesions

Absent Pulmonary Valve Syndrome

Coronary Artery Anomalies

Other Anomalies Requiring Palliative Shunting Prior to Complete Repair

Additional Congenital Cardiac Anomaly

Additional Noncardiac Congenital Anomaly

Physics and Physiology of Systemic Pulmonary Shunting

Anesthesia Issues of Systemic Pulmonary Shunting

Anesthesia Issues of the Patient with a BTS for Complete Repair

Conclusion

Bibliography

Chapter 20: Transposition of the Great Arteries

Case Presentation

Embryology

Terminology and Anatomy

Simple Transposition of the Great Arteries

Clinical Presentation

Historical Therapeutic Approaches and Outcomes

Contemporary Management and Interventions Prior to Surgery

Contemporary Surgical Management and Outcomes

Comorbidities

Additional Anesthetic Considerations

Complex TGA

TGA with Aortic Coarctation

TGA with Conal Septal Deviation

Conal Septal Deviation-TGA/VSD and LVOT Obstruction

Conal Septal Deviation-Taussig Bing Anomaly

Corrected Transposition of the Great Arteries

Addendum on Invasive Monitoring Catheter Insertion: Author’s Opinion

Ultrasound for CVL Placement and Arterial Cannulation

Bibliography

Chapter 21: Right-Sided Obstructive Lesions

Tetralogy of Fallot

Introduction

Anatomy

Presentation

Treatment

Anesthetic Considerations

Congenital Pulmonic Valve Stenosis

Introduction

Anatomy

Presentation

Treatment

Anesthetic Considerations

Pulmonary Atresia with Intact Ventricular Septum

Introduction

Anatomy

Presentation

Treatment

Anesthetic Considerations

Pulmonary Atresia with VSD

Introduction

Anatomy

Presentation

Treatment

Anesthetic Considerations

Ebstein’s Anomaly

Introduction

Anatomy

Presentation

Treatment

Anesthetic Considerations

References

Chapter 22: Congenital Mitral Valve Anomalies

Introduction

Embryology

Classification of Congenital Mitral Valve Anomalies

Anatomical Classification Systems

Surgical Classification

Complex Congenital MV Lesions

Clinical Features

Congenital Mitral Stenosis

Congenital Mitral Regurgitation

Diagnosis

Congenital Mitral Stenosis

Electrocardiography

Chest Radiography

Echocardiography

Transesophageal Echocardiography

Dynamic Three-Dimensional (3D) Transthoracic and Transesophageal Echocardiography

Congenital Mitral Regurgitation

Chest Radiography

Electrocardiography

Transthoracic Echocardiography

Transesophageal Echocardiography (TEE)

3D Echocardiography

Cardiac Magnetic Resonance Imaging

Cardiac Catheterization

Management of Congenital Mitral Valve Anomalies

Timing of Surgery

Anesthetic Management

Mitral Regurgitation

Surgical Techniques

Surgical Outcomes

Conclusion

References

Chapter 23: Congenital Anomalies of the Aortic Valve

Case Scenario #1: Critical Aortic Stenosis of the Neonate

Case Scenario #2: The Ross Procedure

Valvular Aortic Stenosis

Anatomy

Pathophysiology

Critical Aortic Stenosis of the Neonate

The Child or Adolescent with Valvular Aortic Stenosis

Case Scenario #3

Supravalvular Aortic Stenosis

Anatomy and Pathophysiology

Anesthetic Risk Assessment

Treatment

Anesthetic Management

References

Chapter 24: Anomalies of the Aortic Arch: Aortic Coarctation and Interrupted Aortic Arch

Coarctation of Aorta

Introduction and Background

Embryology and Anatomic Features

Etiology and Mechanism of the Disease

Pathologic Findings

Clinical Features

Prenatal Period (Fetal Period)

Neonatal Period

Infancy Period

Older Childhood and Adolescence Period

Adult Features

Echocardiography in CoA

Echocardiographic Views Used in CoA

Echo Protocol

Associated Anomalies of CoA

Associated Cardiac Anomalies of CoA

Aortic Valve Lesions

Hypoplasia of the Left Heart Structures

Hypoplasia of Aortic Arch

Ventricular Septal Defect (VSD)

Patent Ductus Arteriosus (PDA)

Atrial Septal Defect (ASD)

Bovine Aortic Arch

Other Cardiac Anomalies

Associated Noncardiac Anomalies of CoA

CNS

Gastrointestinal System

Urogenital System

Skeletal Anomalies

Chromosomal Anomalies

Urogenital System

Skeletal Anomalies

Therapeutic Approaches

Surgical Correction

Balloon Dilatation

Stenting

Anesthesia for CoA

Preoperative Evaluation

Preoperative Care in Neonatal and Infantile Period

Preoperative Care in Older Children and Adults

Intraoperative Anesthesia Management

Monitoring

CNS Monitoring

Vasoactive Drugs

Spinal Cord Protection Strategies

Patient Positioning

Postoperative Care

Clinical Outcome

Other Forms of Aortic Stenosis

Interrupted Aortic Arch (IAA)

Classification of IAA

Associated Anomalies

Clinical Findings

Treatment

Intraoperative Management

References

Chapter 25: Patent Ductus Arteriosus

References

Chapter 26: Hypoplastic Left Heart Syndrome: Treatment Options

Introduction

Pathology

Diagnosis

Preoperative Care

Stage I Options

Modified Norwood Procedure

Sano Procedure

Hybrid Procedure

Transplantation

Single Ventricle Reconstruction Trial

Hybrid Procedure

Individualized Surgical Approach

Summary

References

Chapter 27: Double-Outlet Right Ventricle

Clinical Vignettes

Case 1

Case 2

Background

Embryology

Anatomy

Coronary Arteries

Clinical Presentation

VSD-Type and TOF-Type DORV

TGA-Type DORV

DORV with Remote VSD

DORV with AVSD

Surgical Repair

VSD-Type and TOF-Type DORV

Mid-spectrum DORV or TGA-Type DORV with PS

TGA-Type DORV

Aortic Outflow Tract Obstruction and Aortic Arch Hypoplasia

Outcomes

Anesthetic Management of Clinical Cases

Case 1

Case 2

References

Chapter 28: Double-Outlet Left Ventricle (DOLV)

Clinical Vignettes

Case 1

Case 2

Background

Embryology

Anatomy

Ventricular Septal Defect

Right- and Left-Sided Obstructive Lesions

Other Associated Anomalies

Coronary Arteries

Conduction System

Clinical Presentation

Subaortic VSD with or Without POTO

Subpulmonic VSD with or Without AOTO

Supracristal and Remote VSD

Right Ventricular Dysfunction

Surgical Repair

Subaortic VSDs

Patent Pulmonary Outflow

Aortic Outflow Tract Obstruction

Single Ventricle

Outcomes

Summary of Clinical Cases

Case 1

Case 2

References

Chapter 29: Pulmonary Hypertension

Introduction

Classification

Clinical Features

Paraclinical Studies

Chest X-Ray

Electrocardiography

Imaging Studies

Management

Pharmacological Treatment

Anesthesia for Patients with Congenital Heart Disease and Pulmonary Hypertension

References

Chapter 30: Right Ventricular Failure

Anatomy and Physiology of the Right Ventricle

Definition

Etiology

Volume Overload

Altered Contractility

Pressure Overload

Pathophysiology

Diagnosis

Echocardiographic Evaluation of the RV

Management

How Do We Protect the RV?

What to Do When the RV Is Failing?

Preload Optimization

RV Failure in the Pediatric Population

Summary

References

Chapter 31: Coronary Artery Anomalies

Introduction

Embryology

Classification (Table 31.1)

Pathology

ALCAPA

Abnormal Right Coronary Artery of the Pulmonary Artery (ARCAPA)

AAOCA

Stenosis or Atresia of the Left Main Coronary Artery

Myocardial Bridges

Coronary Fistulas

Acquired Coronary Disease

Inflammatory Disease

Coronary Artery Allograft Vasculopathy (CAAV)

Diagnostic Tests

EKG

Echocardiography

Chest Radiography

Stress Sestamibi Perfusion Scan

Computerized Tomographic Angiography (CTA)

MRI

Catheterization Laboratory

Management Algorithm

Surgical Management

Anesthetic Considerations

Outcome

Case-based Contents

References

Chapter 32: Heart Transplantation and Mechanical Circulatory Support in the Congenital Heart Pati

Introduction

Heart Transplantation for Congenital Heart Disease

Mechanical Circulatory Support

Conclusion

References

Part V: Postoperative Care

Chapter 33: Postoperative Cardiovascular and Hemodynamic Management in Pediatric Cardiac Surgery

Introduction

Transferring Patient from Operating Room

Monitoring Techniques

Hemodynamic Complications

Low Cardiac Output

Postoperative Bleeding and Cardiac Tamponade

Pulmonary Hypertension

Conclusion

References

Chapter 34: Postoperative Arrhythmias and Their Management

Postoperative Tachyarrhythmias

Supraventricular Tachycardias

Junctional Ectopic Tachycardia

Atrial Tachycardia

AV Nodal Reentrant Tachycardia and AV Reciprocating Tachycardia

Ventricular Tachycardias

Postoperative Bradyarrhythmias

Sinus Node Dysfunction

Atrioventricular Block

Common Surgical Procedures Associated with Postoperative Arrhythmias

Atrial Septal Defect Closure

Ventricular Septal Defect Closure

Atrioventricular Septal Defect Repair

Tetralogy of Fallot Correction

Surgical Repair of Univentricular Heart

Surgical Correction of Transposition of the Great Arteries

References

Chapter 35: Postoperative Respiratory Management in Pediatric Cardiac Surgical Patients

How Does the Pediatric Patient Differ from the Adult Patient?

Anatomy

Physiology

Principals and Goals of Mechanical Ventilation

Ventilation Considerations and Its Challenges Unique to the Congenital Heart Disease Patients

Strategies for Ventilation and Ventilator Modes

Weaning, Readiness for Extubation, and Extubation Failure

Weaning Ventilator Support and Spontaneous Breathing Trials (SBTs)

Prediction Tests for Extubation Success

“Ready for Departure”: Preparing for Extubation

The “Extubation Procedure”

Predictors of Extubation Failure

Noninvasive Ventilation

RAM Cannula

nCPAP

High-Flow Nasal Cannula (HFNC)

Miscellaneous Issues

Extracorporeal CO2 Removal: ECCO2R

HFV or HFOV

Inhalational Routes of Drug Delivery

Chest Physiotherapy

Chronic Respiratory Failure and Tracheostomy

References

Chapter 36: Cardiac Anesthesia in Infants and Children: Postoperative Bleeding and Coagulation Ma

Introduction

Risk Factors for Postoperative Bleeding

Preoperative Risk Factors

Intraoperative Risk Factors

Pathophysiology of Postoperative Bleeding

Point of Care Testing and Algorithms in Postoperative Bleeding

Prophylaxis

Preoperative Optimization

Intraoperative

General Measures

Prophylactic Agents

Antifibrinolytics (Table 36.3)

Treatment

Abnormal Clot Generation

Prothrombin Complex Concentrates (PCCs)

Activated Factor VII

Abnormal Clot Stability

Antifibrinolytics

Clot Firmness

Fibrinogen Concentrate

Cryoprecipitate

Platelets

Fresh Frozen Plasma

Packed Red Blood Cells

Adverse Effects (Table 36.6)

Outcome

Case Vignette

References

Chapter 37: Postoperative Central Nervous System Management in Patients with Congenital Heart Dise

The Impact of CNS Outcome in Pediatric Cardiac Surgery

Risk Factors for CNS Injury in Neonates and Infants Undergoing Cardiac Surgery

Preoperative Risk Factors for CNS Injuries in Neonates and Children

Intraoperative Risk Factors for CNS Injuries in Neonates and Children

Postoperative Risk Factors for CNS Injuries in Neonates and Children

Classification of CNS Deficits

Neurologic Deficits

Neonatal Seizure

Neurocognitive and Neurodevelopmental Disorders

White Matter Injuries (WMI) Including Periventricular Leukomalacia (PVL)

Etiology (Including Predisposing Factors and Mechanisms of Injury)

Prevalence

Clinical Presentation of PVL

Diagnosis

Treatment

Clinical Assessment and Monitoring of Delirium in Pediatric Cardiac Surgery

Treatment of Postoperative Delirium

CNS Monitoring

References

Chapter 38: Perioperative Management Endocrine Problems in Pediatric Cardiac Surgical Patients

Perioperative Management of Patients on Steroids Requiring Surgery

When to Suspect an Impaired HPA Axis?

Patients with Non-suppressed HPA Axis

Patients with Uncertain Status of HPA Axis

Other Groups of Patients

Patients Using Inhaled Steroids

Patients Using Topical Steroids

Patients Using Intra-articular and Spinal Glucocorticoid Injections

Guidelines for Dosing Glucocorticoids in the Perioperative Period

Surgical Procedures

Pituitary Gland in Perioperative Period

Central Adrenal Insufficiency

Central Hypothyroidism

Central Diabetes Insipidus (DI)

In Conclusion

Perioperative Management of Diabetes Mellitus in Children

Introduction

Intraoperative Care

Postoperative Care

For Emergency Surgery

Perioperative Management in Patients with Metabolic Disorders

Introduction

Hypoglycemia

Phenylketonuria

Preoperative Management

Propionic and Methylmalonic Acidemia

Preoperative Management

Postoperative Management

Maple Syrup Urine Disease

Preoperative Management

Urea Cycle Defects

Preoperative Management

Fatty Acid Oxidation Defects

Homocystinuria

Mucopolysaccharidosis

Preoperative Management

Postoperative Management

References

Chapter 39: Perioperative Pain Management in Patients with Congenital Heart Disease

Introduction

Chronic Postsurgical Pain

Pain After Sternotomy

Pain After Thoracotomy

Management of CPTP and Post-sternotomy Pain

Useful Regional Techniques in Patients with Congenital Heart Disease

Neuraxial Blocks

Peripheral Block Techniques

Paravertebral Blocks

Pecs Blocks/Serratus Plane Block

Transversus Abdominis Plane (TAP) Block

References

Chapter 40: Postoperative Renal Management, Fluid/Electrolyte Management and Acid–Base Disorders

Introduction

Physiology: From Birth to Adults

Fluid Balance and Distribution

Fluid and Solute Movements

Electrolyte Balance

Sodium

Potassium

Calcium

Phosphorus

Magnesium

Chloride

Bicarbonate

Acid–Base Balance

Renal Physiology

Renal Blood Flow

Glomerular Filtration Rate

Urine Concentration and Sodium Excretion Fraction

Acute Kidney Injury After Congenital Heart Disease Surgery

Epidemiology of AKI

Aetiology and Pathogenesis of AKI Post-Cardiac Surgery

CPB and Ultrafiltration

Physiopathology

Ultrafiltration

Clinical Pictures

Classification and Diagnosis

RIFLE Classification System

pRIFLE Classification System

AKIN Classification System

Difference Between RIFLE, pRIFLE and AKIN Classification

The Multi-societal Database Committee for Pediatric and Congenital Heart Disease Classification

Lab Findings: New Biomarkers

Neutrophil Gelatinase-Associated Lipocalin (NGAL)

Interleukin 18

Cystatin C

Treatment Course

Fluid Management

Fluid Overload

Goal-Directed Fluid Therapy

Type of Fluid Solution

Colloids

Crystalloids

Concerns Regarding Paediatric Patients

Parental Nutrition

Monitoring Daily Fluid Balance

Pharmacologic Management of Fluid Overload

Dopamine

Loop Diuretics

Nesiritide

Fenoldopam

Renal Replacement Therapy

Peritoneal Dialysis

Continuous Renal Replacement Therapy

Electrolyte Management

Sodium

Potassium

Calcium

Magnesium

Basis of Pathophysiology Acid–Base Balance in the Postoperative ICU Setting of Cardiac Surger

Metabolic Acidosis

Metabolic Alkalosis

Respiratory Acidosis and Alkalosis

A Practical Approach to…

Fluid Management

Renal Management

Acid–Base Disorders Management

Bibliography

Part VI: Anesthesia and Critical Care Outside the Cardiac Operating Room

Chapter 41: Congenital Cardiac Intensive Care and Management of Cardiac Arrest

Background

Cardiovascular Physiology and Shock

Pulmonary Vascular Resistance (PVR) and Pulmonary Blood Flow (PBF) Regulation

Heart Disease and Cerebral Function

Pharmacology

Epidemiology, Prevention, and Outcome of In-Hospital Cardiopulmonary Arrest in CHD Patients

Diagnosis of Cardiac Arrest

Mechanics of Cardiopulmonary Resuscitation

Airway

Breathing

Circulation

Mechanisms of Blood Flow

Rate and Duty Cycle

Defibrillation and Cardioversion

Electric Countershock

Practical Aspects of Defibrillation in Children

Open-Chest Defibrillation

Automated External Defibrillation

Transcutaneous Cardiac Pacing

Vascular Access and Monitoring During Cardiopulmonary Resuscitation

Vascular Access and Fluid Administration

Endotracheal Medication Administration

Monitoring During Cardiopulmonary Resuscitation

Medications Used During Cardiopulmonary Resuscitation

α- and β-Adrenergic Agonists

Epinephrine

Vasopressin

Atropine

Sodium Bicarbonate

Calcium

Glucose

Amiodarone

Lidocaine

Special Cardiac Arrest Situations

Perioperative Cardiac Arrest

Hyperkalemia

References

Chapter 42: Pediatric Cardiac Surgery in Emerging Countries

The Burden of Congenital Heart Disease in the World and in Emerging Nations in Particular

Shortages and Solutions

Human Resources

Developing a Sustainable Congenital Heart Center in an Emerging Country

Models of Assistance

A Success Story

Analysis of the Five Main Areas of Program Assistance

On-Site Surgical and Interventional Activity

Education

Biomedical Engineering Support

A Different Way of Doing Business

Development of a Teamwork Culture with Nurse Empowerment and a Horizontal Hierarchy

Data Collection

Data Monitoring

Summary

References

Index

 

An aparitie	1 Apr 2017
Autor	Ali Dabbagh,‎ Antonio Hernandez Conte,‎ Lorraine Lubin
Dimensiuni	16.1 x 5.7 x 24.3 cm
Editura	Springer
Format	Hardcover
ISBN	9783319446899
Limba	Engleza
Nr pag	1025