Paediatric anaesthesia
-
Paediatric anaesthesia · May 2019
ReviewRisk associated with anesthesia for non-cardiac surgery in children with congenital heart disease.
Database analysis has indicated that perioperative cardiac arrest occurs with increased frequency in children with congenital heart disease. Several case series and large datasets from ACS NSQIP have identified subgroups at the highest risk. ⋯ How hospitals and health care systems apply these guidelines to provide safe care for these challenging patient groups requires the application of modern quality improvement techniques. Each institution should develop a system which reflects local expertise and resources.
-
Paediatric anaesthesia · May 2019
ReviewUse of antifibrinolytics in pediatric cardiac surgery: Where are we now?
Fibrinolytic activation is a major and preventable source of bleeding in neonates and children undergoing cardiac surgery with cardiopulmonary bypass. Based on the existing literature (adult and pediatric; cardiac and noncardiac), prophylactic administration of antifibrinolytic agents can help reduce fibrinolytic activation, and consequently reduces perioperative bleeding and the requirement for blood product transfusion. Due to the increased risk of renal failure and mortality reported in adults undergoing cardiac surgery, aprotinin should not be considered as a safe option in neonates and children. ⋯ Further studies are therefore urgently needed to better define the optimal dose regimen to be used in neonates and children. In the meantime, the dose regimen published in the most recent pharmacokinetic studies can be used. Although no studies have assessed the effect of massive bleeding and transfusion on the plasmatic concentrations of the lysine analogs, additional boluses might be considered in the presence of bleeding and/or when signs of fibrinolytic activations are observed on viscoelastic hemostatic assays.
-
Paediatric anaesthesia · May 2019
ReviewAnesthetist-delivered intraoperative transesophageal echocardiography in pediatric cardiac surgery.
This article reviews the evidence for anesthetist-delivered perioperative transesophageal echocardiography for children undergoing cardiac surgery. It addresses the additional issues of training, developing practice, accreditation, and the requirement for collaboration with pediatric cardiologists, surgeons and other members of the perioperative team. Finally an overview of the potential structure of an anesthetist-delivered perioperative transesophageal echocardiography service is presented.
-
Paediatric anaesthesia · May 2019
ReviewRole of echocardiography in the assessment of right ventricular function in the pediatric population.
This review article summarizes the use of echocardiography in the evaluation of the right ventricle with special emphasis on pediatric patients. After reading this article, anesthesiologists will develop a better understanding of the anatomy and echocardiographic parameters for hemodynamic and functional assessment of the right ventricle. This knowledge will assist with the perioperative management of patients with cardiopulmonary disorder.