Anesthetic management of an infant with lupus and congenital complete heart block

Sreevastava, DK; Setlur, Rangraj; Sharma, Vipul; Padmini, H S; Puri, Bipin; Bhargava, A K

doi:10.1111/j.1460-9592.2005.01754.x

Cited by 4 publications

(2 citation statements)

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“…(1,5) The use of prophylactic temporary transvenous pacing has been reported in a 3.6-kg neonate with CCHB who underwent exploratory laparotomy. (6) This method was chosen by Sreevastava et al due to the nonavailability of a transcutaneous pacing system for an infant of this size. (6) Although we posit that the transcutaneous method is potentially feasible in such situations and is preferable to the more invasive transvenous method, we were fortunate enough not to have to put our modified pads to the test.…”

Section: Discussionmentioning

confidence: 99%

“…(6) This method was chosen by Sreevastava et al due to the nonavailability of a transcutaneous pacing system for an infant of this size. (6) Although we posit that the transcutaneous method is potentially feasible in such situations and is preferable to the more invasive transvenous method, we were fortunate enough not to have to put our modified pads to the test. Thus, in light of this, the feasibility of transcutaneous pacing in the neonatal population would be a possible area for future investigation.…”

Section: Discussionmentioning

confidence: 99%

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Anaesthetic management of a premature low-birth-weight neonate with congenital complete heart block for implantation of temporary epicardial pacing wires

Shahani²

2014

smedj

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C a s e R e p o r t e9 I NTRO D U C TIO NComplete congenital heart block (CCHB) is a rare condition with an incidence of 1 in 20,000 live births.(1) Neonates with CCHB often require surgery (and therefore anaesthesia) for the insertion of temporary or permanent electronic pacing wires.As this condition occurs infrequently, the most favourable method of induction and maintenance of anaesthesia is unclear, although several techniques have been used. We herein report the anaesthetic conduct of a low-birth-weight neonate who underwent temporary epicardial pacing wire insertion with good outcome. CA S E R EPO RTThe mother of our patient was a 24-year-old Malay woman with no prior known medical problem. She had previously undergone a full term pregnancy that culminated in a normal vaginal delivery of a healthy baby three years prior to the current presentation. During this current pregnancy, screening at 23 weeks of gestation demonstrated fetal heart block with an atrial rate of 130-140 bpm and a ventricular rate of 48-51 bpm.The mother was subsequently found to be positive for antiribonucleoprotein, anti-Ro, anti-La and antinuclear antibodies, but negative for anti-ds DNA, anti-Smith, anti-Scl-70 and anti-Jo-1 antibodies. She was diagnosed with Sjögren's syndrome, and was started on 8 mg dexamethasone once every morning and 4 mg salbutamol three times a day at 25 weeks of gestation in an attempt to increase the fetal heart rate.However, salbutamol was stopped a week later as the mother Anaesthetic management of a premature low-birthweight neonate with congenital complete heart block for implantation of temporary epicardial pacing wires ABSTRACT The optimal anaesthetic management of neonates with complete congenital heart block (CCHB) is unknown, as there is a low incidence of such cases. Neonates with CCHB often require surgery for the initiation of electronic pacing. In addition to the challenges of anaesthetising a neonate, this procedure is risky due to the potential for hypotension, arrhythmias and cardiac arrest. We herein present the case of a premature low-birth-weight neonate with antibody-related CCHB and normal heart structure who underwent anaesthesia and surgery for epicardial pacing wire insertion on Day 1 of life. We also compare our patient's anaesthetic conduct and outcome with similar previously reported cases.

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