Introduction
The field of congenital cardiac anesthesia has witnessed significant advancements and emerging practices over the recent years. A review article published in the Journal of Cardiothoracic and Vascular Anesthesia has highlighted the selected 2018 highlights in congenital cardiac anesthesia. This comprehensive review, authored by Viviane G. Nasr, Erin A. Gottlieb, Adam C. Adler, Michael A. Evans, Amod Sawardekar, James A. DiNardo, Emad B. Mossad, and Alexander J.C. Mittnacht, summarizes the major developments and studies that have contributed to the field in 2018. The article, published on July 16, 2020, provides insights into key areas of congenital cardiac anesthesia, including the management of patients with high-risk congenital heart disease (CHD) presenting for noncardiac surgery, cardiopulmonary resuscitation in infants and children with CHD, dexmedetomidine use in pediatric patients, the application of point-of-care lung ultrasound, and regional anesthesia in pediatric cardiac surgery.
The Patient with High-Risk CHD Presenting for Noncardiac Surgery
Patients with CHD often require surgical interventions that are not related to their cardiac condition. The complexity of their underlying cardiac pathology makes noncardiac surgery a high-risk endeavor. The review delves into various strategies and guidelines that aim to minimize risk and optimize outcomes for these vulnerable patients. A multidisciplinary approach involving cardiologists, anesthesiologists, and surgeons is emphasized to manage the unique challenges these patients face.
Cardiopulmonary Resuscitation in Infants and Children with CHD
Cardiopulmonary resuscitation (CPR) in infants and children with CHD requires specialized considerations due to the anatomical and physiological differences in this population. The review highlights the latest research in 2018 that sheds light on the most effective techniques, modifications, and challenges in performing CPR on this sensitive group. It also stresses the importance of tailored resuscitation protocols that take into account the specifics of various congenital cardiac defects.
Dexmedetomidine Use in Pediatric Patients
Dexmedetomidine, a selective α2-adrenoceptor agonist, has been increasingly used in pediatric anesthetic practice for its sedative and analgesic properties, with a reduced risk of respiratory depression. The review article discusses the pharmacological profile of dexmedetomidine and its application in pediatric cardiac anesthesia. It also examines emerging literature that supports its use in children with CHD, citing its potential benefits in various perioperative contexts.
Point-of-Care Lung Ultrasound
The emergence of lung ultrasound as a point-of-care diagnostic tool has had a significant impact on congenital cardiac anesthesia. Its non-invasiveness, lack of radiation exposure, and ability to provide real-time information about the pulmonary status make it invaluable in the perioperative management of pediatric cardiac patients. The authors summarize the evidence that supports the use of lung ultrasound in the assessment of lung pathology and the guidance of fluid management in this population.
Regional Anesthesia in Pediatric Cardiac Surgery
The utility of regional anesthesia techniques in managing postoperative pain for pediatric cardiac surgery patients is explored thoroughly in the review. In addition to the analgesic benefits, the authors suggest that regional anesthesia may also have positive implications for the overall recovery process, reduction in opioid use, and potential cardiovascular stability.
This news article aims to provide an in-depth understanding of the major strides taken in congenital cardiac anesthesia based on the 2018 literature. The review in the Journal of Cardiothoracic and Vascular Anesthesia reflects the collective efforts of leading experts in the field to synthesize and share knowledge that can enhance clinical practice and patient care.
References
1. Nasr VG, Gottlieb EA, Adler AC, et al. Selected 2018 Highlights in Congenital Cardiac Anesthesia. J Cardiothorac Vasc Anesth. 2019;33(10):2833-2842. doi: 10.1053/j.jvca.2019.03.013
2. Putnam LR, Chang CM, Rogers AJ, et al. Adherence to Surgical Care Improvement Project Measures and Post-Operative Surgical Site Infections Following Noncardiac Surgery. Am J Surg. 2018;215(1):24-30. doi:10.1016/j.amjsurg.2017.08.025
3. Sharek PJ, Parast LM, Leong K, et al. Effect of a Rapid Response Team on Hospital-Wide Mortality and Code Rates Outside the ICU in a Children’s Hospital. JAMA. 2007;298(19):2267-2274. doi:10.1001/jama.298.19.2267
4. Tobias JD, Green TP, Cote CJ. Handbook of Pediatric Anesthesia. McGraw Hill Professional; 2014.
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Keywords
1. Congenital Cardiac Anesthesia
2. Pediatric Cardiology
3. Dexmedetomidine Pediatric Use
4. Regional Anesthesia Pediatric Surgery
5. POCUS Cardiac Anesthesia