Anesthesia for congenital heart disease by Andropoulos, Dean B

By Andropoulos, Dean B

This well timed revision displays the fast advances in surgical procedure and anesthesia for congenital middle affliction that experience happened in recent times, together with neonatal cardiac surgical procedure and anesthesia, remedy of unmarried ventricle sufferers, new diagnostic modalities, and advancements within the catheterization laboratory. New chapters deal with mechanical help of the move, embryology, and quality/outcomes management.

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This well timed revision displays the fast advances in surgical procedure and anesthesia for congenital middle sickness that experience happened in recent times, together with neonatal cardiac surgical procedure and anesthesia, Read more...

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This is the first paper published in pediatric cardiac anesthesia. It describes the anesthetic management, intraoperatively and postoperatively, given to 100 patients operated on by Dr. Alfred Blalock for the surgical treatment of congenital pulmonary stenosis or atresia. 14 Keats AS, Kurosu Y, Telford J, Cooley DA. Anesthetic problems in cardiopulmonary bypass for open heart surgery. Experiences with 200 patients. Anesthesiology 1958;19:501–14. This is one of the first papers describing the anesthetic problems during bypass, including oxygenation, hypothermia, blood replacement, ventricular fibrillation, atrioventricular block, and pulmonary complications.

Although a relationship of clinical outcomes to the training and education level of the healthcare provider has yet to be demonstrated, there is still the potential for a structured curriculum to positively impact quality of care and allocation of healthcare resources. van der Leeuw et al. completed a systematic review of the effect of resident training on patient outcome. They concluded that with adequate supervision, contingencies for additional OR time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes.

In the past, the outcome criterion most emphasized for treatment of CHD was survival. Now that survival rates are very good and getting better for almost all forms of CHD, attention has turned to the quality of that survival. Recent concerns about the effect of anesthetic agents on the developing brain have prompted extensive efforts to study the magnitude of the effect of these agents, the mechanism of the effect, and whether alternative agents or protective strategies are warranted [73]. Neonatal cardiac surgery patients must have surgery at a vulnerable age and also potentially suffer from brain injury from cyanosis, bypass techniques, inflammation, or low cardiac output, and mechanical support devices are a particularly important focus of study.

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