Changes in cerebral saturation profile in response to mechanical ventilation alterations in infants with bidirectional superior cavopulmonary connection*

Mott, Antonio R.; Alomrani, Ahmed; Tortoriello, Tia A.; Perles, Zeev; East, Debora L.; Stayer, Stephen A.

doi:10.1097/01.pcc.0000224949.25692.87

Cited by 22 publications

(6 citation statements)

References 17 publications

(21 reference statements)

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“…In 2 LOE 5 studies 669,670 of patients with BDG circulation who were not in cardiac arrest or a prearrest state, excessive ventilation reduced cerebral oxygenation. In 2 LOE 5 studies 671,672 of patients following a Fontan procedure who were not in cardiac arrest or a prearrest state, negative-pressure ventilation improved stroke volume and cardiac output compared with intermittent positive-pressure ventilation.…”

Section: Special Situationsmentioning

confidence: 99%

Part 10: Pediatric Basic and Advanced Life Support

Kleinman

Caen

Chameides³

et al. 2010

Circulation

183

184

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Note From the Writing Group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (eg, “Family Presence During ResuscitationPeds-003”). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.

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Section: Special Situationsmentioning

confidence: 99%

Part 10: Pediatric Basic and Advanced Life Support

Kleinman

Caen

Chameides³

et al. 2010

Circulation

183

184

View full text Add to dashboard Cite

show abstract

“…However, hypercarbia, acidosis, and elevated airway pressure should be avoided because pulmonary blood flow remains dependent on PVR. However, hypocarbia may exacerbate a decrease in cerebral blood flow and reduce venous return from the brain and upper body [17]. If there is high pressure in the superior vena cava, the head and the tongue may become congestive due to disturbance in venous return.…”

Section: Single Ventricular Physiologymentioning

confidence: 99%

Who are at high risk of mortality and morbidity among children with congenital heart disease undergoing noncardiac surgery?

Song

Shin

2021

Anesth Pain Med

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With advances in the development of surgical and medical treatments for congenital heart disease (CHD), the population of children and adults with CHD is growing. This population requires multiple surgical and diagnostic imaging procedures. Therefore, general anesthesia is inevitable. In many studies, it has been reported that children with CHD have increased anesthesia risks when undergoing noncardiac surgeries compared to children without CHD. The highest risk group included patients with functional single ventricle, suprasystemic pulmonary hypertension, left ventricular outflow obstruction, and cardiomyopathy. In this review, we provide an overview of perioperative risks in children with CHD undergoing noncardiac surgeries and anesthetic considerations in patients classified as having the highest risk.

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“…Relative hypoventilation with increased systemic arterial PCO 2 (6-8 kPa) improves systemic (cerebral) oxygenation through lower cerebral vascular resistance and increased SVC and pulmonary blood flow. (22,23) Early onset of spontaneous ventilation and extubation leading to intermittent negative intra-thoracic pressure improve SVC and pulmonary blood flow (a similar effect is achievable by negative pressure ventilation where necessary). A focus on lusitropic myocardial support and systemic vasodilatation (phosphodiesterase inhibitorsmilrinone or enoximone, ACE inhibitors) is beneficial given the adverse postoperative changes in myocardial function and systemic vascular resistance (increased ventricular wall to cavity ratio, diastolic dysfunction, increased systemic vascular resistance).…”

Section: Bidirectional Superior Cavopulmonary Anastomosismentioning

confidence: 99%

The Fontan circulation: evolution of a concept

Slavík¹

2009

Cor Vasa

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The Fontan circulation is a specific haemodynamic concept developed and modified over the past 50 years to treat paediatric patients with complex congenital heart defects. The common denominator for these defects is usually a single dominant ventricle supporting both systemic and pulmonary circulation together with cyanosis since birth. Two main palliative cardiac surgical procedures (bidirectional superior cavopulmonary and total cavopulmonary anastomosis) are currently used to establish the Fontan circulation. Refinement of surgical techniques and improved understanding of perioperative and postoperative complications led to improvement in the survival of children and adults with complex congenital heart defects. Key words: Fontan circulation -Superior bidirectional cavopulmonary anastomosis -Total cavopulmonary anastomosis -Complex heart defects Slavik Z. Fontanova cirkulace: vývoj koncepce. Cor Vasa 2009;51(6):410-414.Fontanova cirkulace je specifická hemodynamická koncepce vyvinutá a modifikovaná za posledních padesát let k léčbě dětských pacientů s komplexními vrozenými srdečními vadami. Společným jmenovatelem těchto vad je obvykle jedna dominantní srdeční komora podporující jak systémovou, tak i plicní cirkulaci společně s cyanózou od narození. Dnes se k vytvoření Fontanovy cirkulace užívají především dva paliativní kardiochirurgické výkony (horní bidirekční kavopulmonální a totální kavopulmonální anastomózu). Zlepšení chirurgických postupů a lepší porozumění operačním a pooperačním komplikacím vedlo ke zlepšenému přežití dětí a dospělých s komplexními srdečními vadami. Klíčová slova: Cyanóza -horní bidirekční kavopulmonální anastomóza -Totální kavopulmonální anastomóza -Komplexní srdeční vady

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Changes in cerebral saturation profile in response to mechanical ventilation alterations in infants with bidirectional superior cavopulmonary connection*

Abstract: Hyperventilation can potentially cause a decrease in cerebral oxygenation and should be avoided in children with bidirectional superior cavopulmonary connection. Normoventilation and mild respiratory acidosis, however, preserve cerebral oxygenation in these patients.

Cited by 22 publications

References 17 publications

Part 10: Pediatric Basic and Advanced Life Support

Part 10: Pediatric Basic and Advanced Life Support

Who are at high risk of mortality and morbidity among children with congenital heart disease undergoing noncardiac surgery?

The Fontan circulation: evolution of a concept

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