TY  - CHAP
M1  - Book, Section
TI  - Chapter 179. Basics of Pediatric Cardiac Anesthesia
A1  - Wilkens, Eric P.
A2  - Atchabahian, Arthur
A2  - Gupta, Ruchir
PY  - 2013
T2  - The Anesthesia Guide
AB  - Patients  with  repaired  cardiac  congenital  disease  are  being  seen  more  and  more  often  for  noncardiac  surgery:  important  to  understand  lesions  and  repairsCongenital  heart  defects  have  an  incidence  of  between  4  and  50  per  1,000  live  birthsMost  common:  ventricular  septal  defect  (VSD):Most  resolve  spontaneously  in  the  first  few  years  of  lifeLarger  ventricular  defects  (>5  mm)  have  a  higher  rate  of  spontaneous  closure  than  smaller  VSDsFour  most  important  physiologic  pearls  for  congenital  heart  disease:Know  primary  lesion  shunt  direction  and  lesionLeft-to-right  shunt  (noncyanotic):Atrial  septal  defect  (ASD)VSDPatent  ductus  arteriosus  (PDA)Right-to-left  shunt  (cyanotic):  examples  include  tetralogy  of  Fallot,  pulmonary  atresia,  tricuspid  atresia,  Ebstein  anomalyComplex  shunt:  truncus  arteriosus,  transposition  of  the  great  vessels,  total  anomalous  pulmonary  venous  return,  hypoplastic  left  heart  syndromeObstructive  lesions:Aortic  stenosis  (AS)Mitral  stenosis  (MS)Pulmonic  stenosis  (PS)Coarctation  of  the  aortaKnow  initial  arterial  oxygen  saturationKnow  pulmonary  to  systemic  blood  flow  ratio  (Qp/Qs)Know  the  primary  cardiac  valve  lesions  (restrictive  or  regurgitant)Knowing  where  the  blood  flows  and  in  what  proportion  allows  the  provider  to  try  to  maintain  a  Qp/Qs  ratio  appropriate  for  the  patientInfluencing  pulmonary  vascular  resistance  (PVR)  is  the  most  important  way  we  have  to  optimize  circulation  in  these  patientsCarbon  dioxide:  hyperventilation  and  the  resulting  respiratory  alkalosis  decrease  pulmonary  resistance;  hypoventilation  and  respiratory  acidosis  raise  itNitrates:  medications  such  as  inhaled  nitric  oxide  (5–40  ppm)  or  medications  that  affect  the  intracellular  nitric  oxide  pathway  (e.g.,  sildenafil)  decrease  PVRMilrinone  (an  inotrope  with  vasodilatory  effects)  can  decrease  PVR  and  increase  the  ability  of  the  right  heart  to  contractInhaled  or  infused  prostaglandins  (inhaled:  5–50  μg/h;  infused:  start  at  2  μg/h)  selectively  decrease  PVRA  simplified  template  of  normal  blood  flow  is  available  below  (Fig.  179-3)Simpler  procedures,  such  as  ASD  and  some  VSDs,  are  amenable  to  extubation  in  the  OR.  Other  procedures,  such  as  repair  of  PDA  or  repair  of  other  lesions  such  as  hypoplastic  left  heart  syndrome  or  arterial  switch  procedures,  involve  complicated  vessel  and  cardiac  repair  and  are  likely  to  require  sedation  and  mechanical  ventilation  postoperatively  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=57263357
ER  -