Anesthesia for high‐risk procedures in the catheterization laboratory

Abstract

Summary Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus‐dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic‐related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.

Sedation and anaesthesia for cardiac catheterisation

“…• PDA device closure in premature and low weight infants. 12 • Stenting of vertical vein in newborns with total anomalous pulmonary venous return.…”

Patient monitoring in the nonoperating room anesthesia (NORA) setting: current advances in technology

“…As new procedures have been developed, locations and equipment required to administer safe anesthetics to patients in these diverse locations have also evolved [3][4][5]. The space ceded for these interventional procedures was often small and cramped.…”

Response from the manufacturer to Shah, B. and Peiris, K., regarding their correspondence ''Dräger Ventilator—Ventilates without Fresh Gas Flow''

“…2 In this specific case described by Dr Shah, the anesthesia provider did not switch the anesthesia machine completely to automatic ventilation as described in the Instructions for Use. 1 The fresh gas was still delivered to the ACGO outlet of the machine while the patient was connected to the circle system. Therefore no fresh gas was delivered to the patient.…”