SCAI/CCAS/SPA Expert Consensus Statement for Anesthesia and Sedation Practice: Recommendations for Patients Undergoing Diagnostic and Therapeutic Procedures in the Pediatric and Congenital Cardiac Catheterization Laboratory

Abstract

Current practice of sedation and anesthesia for patients undergoing pediatric and congenital cardiac catheterization laboratory (PCCCL) procedures is known to vary among institutions, a multi-society expert panel with representatives from the Congenital Heart Disease Council of the Society for Cardiovascular Angiography and Interventions, the Society for Pediatric Anesthesia and the Congenital Cardiac Anesthesia Society was convened to evaluate the types of sedation and personnel necessary for procedures performed in the PCCCL. The goal of this panel was to provide practitioners and institutions performing these procedures with guidance consistent with national standards and to provide clinicians and institutions with consensus-based recommendations and the supporting references to encourage their application in quality improvement programs. Recommendations can neither encompass all clinical circumstances nor replace the judgment of individual clinicians in the management of each patient. The science of medicine is rooted in evidence, and the art of medicine is based on the application of this evidence to the individual patient. This expert consensus statement has adhered to these principles for optimal management of patients requiring sedation and anesthesia. What follows are recommendations for patient monitoring in the PCCCL regardless of whether minimal or no sedation is being used or general anesthesia is being provided by an anesthesiologist.

Comparison of Outcomes of Pediatric Catheter Ablation by Anesthesia Strategy: A Report From the NCDR IMPACT Registry

“…An operator-directed sedation strategy, which is commonly used in the adult electrophysiology lab and in pediatric interventional cardiology cases, was quite rare in this cohort. [19][20][21] We hypothesized that catheter ablation performed under GA would have higher success rates. Controlled ventilation has been demonstrated to improve catheter contact and energy delivery.…”

An update on pediatric sedation techniques in nonoperating room locations

“…Although the Objective Risk Assessment Tool for Sedation and the Comfort Assessment for Sedation [23] are typically utilized to determine levels of sedation in the pediatric intensive care unit, both tools can be adapted to the NORA setting by nonanesthesiologist providers. Similarly, the Catheterization RISk score for Pediatrics score helps providers determine which children require the presence of an anesthesiologist in the catheterization lab [25,26].…”

Congenital heart diseases and anaesthesia

“…The usual procedural risks during various catheterisation laboratory interventions are coronary ischaemia, cardiac arrest, low cardiac output, RV failure, pulmonary hypertensive crisis, arrhythmias, cardiac perforation and tamponade. [ 12 ]…”

“…Standard pre-operative fasting guidelines should be followed, keeping in mind dehydration, high haematocrit and the need for adequate preload. [ 12 ] Appropriate monitors should be applied before induction of anaesthesia if the child is cooperative. Intravenous (IV) or inhalation induction may be carried out, depending on the availability of (IV) access, and the child's physiological condition and cooperation.…”

“…[ 19 ] Respiratory events are more common in infants and intubated patients. [ 12 ] Risk of adverse events is highest with neonates and infants, followed by children and then GUCHD adults. Risk of cardiac arrest is more during interventional procedures such as VSD device closure, in neonates, and can be attributed to stiff wires and catheters inducing arrhythmias[ 20 21 ] [ Table 7 ].…”