Spinal anaesthesia in a child with hypoplastic left heart syndrome

Sacrista, S.; Kern, Delphine; Fourcade, Olivier; Izard, Philippe; Galinier, P.; Samii, Kamran; Cathala, B

doi:10.1046/j.1460-9592.2003.00961.x

Cited by 16 publications

(10 citation statements)

References 18 publications

(20 reference statements)

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“…Prior limited case reports/small series describe successful use of awake SA for NCS in pediatric patients with CHD (13)(14)(15)(16)(17). The major concern in the use of SA in patients with CHD is the potential for adverse effects on hemodynamic function.…”

Section: Discussionmentioning

confidence: 99%

Spinal anesthesia for noncardiac surgery in infants with congenital heart diseases

Kachko

Birk

Simhi

et al. 2011

Pediatric Anesthesia

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Spinal anesthesia (SA) in pediatrics began to be used in the late nineteenth century in multiple procedures, with priority for high-risk and former preterm infants, for its suggested protective role compared to the development of postoperative apnea with general anesthesia (GA). In children, higher doses of local anesthetics are required with a shorter duration of action and a greater hemodynamic stability compared to adults. The puncture must be performed in the L4-L5 or L5-S1 spaces to prevent spinal injuries. The practice of SA in pediatric patients requires skill and experience; failure rates of up to 28% have been reported. The drugs most commonly used for SA are tetracaine and bupivacaine alone or with adjuvants. SA complications are rare and often without consequences, except for postdural puncture headaches and backaches. Although SA is today considered safe and effective for pediatric patients, it remains relatively underutilized compared to GA.

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Section: Discussionmentioning

confidence: 99%

Spinal anesthesia for noncardiac surgery in infants with congenital heart diseases

Kachko

Birk

Simhi

et al. 2011

Pediatric Anesthesia

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“…However, some patients are required to have noncardiac surgeries even before cardiac intervention. Several case reports have described anesthetic management for these patients [22][23][24]. Noncardiac surgeries for this population occur mostly on emergent basis.…”

Section: Presurgical Repairmentioning

confidence: 99%

Anesthetic management of noncardiac surgery for patients with single ventricle physiology

2011

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Patients with congenital heart diseases are a growing population, and noncardiac surgeries will become an important health care issue. Patients with single ventricle physiology are a particularly challenging population who will undergo staged, palliative repair toward a final step of Fontan circulation. Although Fontan surgery creates a serial circulation in which the ventricle pumps blood to the systemic circuit, pulmonary blood flow occurs without a dedicated ventricle. Despite progress in outcomes, this abnormal circulation remains associated with various co-morbidities such as ventricular dysfunction, arrhythmias, protein losing enteropathy, and plastic bronchitis. Health care professionals must prepare for these patients to present to noncardiac surgery at any stage of intervention, possibly with complications. Given that staged, palliative repair has undergone multiple modifications, patients who present for surgery can vary in types and timing of the repair. Anesthesiologists who care for them must be familiar with perioperative issues to optimize outcomes, especially because congenital heart disease is a risk factor for increased mortality for noncardiac surgery.

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“…Despite these data, the potential for hemodynamic changes should always be considered and appropriate monitoring be employed with ready access to resuscitation medications if needed. The potential safety of this approach is further supported by observational studies reporting no clinically significant reduction in blood pressure or oxygen saturation in high-risk infants with CHD during spinal anesthesia (Table 1) [28][29][30][31][32][33][34][35][36]. In these studies in infants and children with CHD, spinal anesthesia provided stable hemodynamic parameters without excessive hypotension requiring the administration of fluid or inotropic agents.…”

Section: Discussionmentioning

confidence: 92%

Spinal Anesthesia for Urologic Surgery in an Infant With Palliated Single Ventricle Physiology

et al. 2016

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Although commonly practiced in the adult population, spinal anesthesia has seen sporadic use in the pediatric population, being employed historically as a means of avoiding apnea following general anesthesia with halothane. With the emergence of evidence that specific anesthetic agents may affect future neurocognitive outcomes, there has been an increased focus on alternatives to general anesthesia, including spinal anesthesia. However, spinal anesthesia may also have applications in patients with co-morbid conditions that increase the risk of general anesthesia. We present the use of spinal anesthesia during urologic surgery in a 19-month-old boy with hypoplastic left heart syndrome who had undergone surgical palliation. The use of spinal anesthesia in patients with congenital heart disease is reviewed, potential hemodynamic consequences are presented, and the use of spinal anesthesia as an alternative to general anesthesia is discussed.

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Spinal anaesthesia in a child with hypoplastic left heart syndrome

Cited by 16 publications

References 18 publications

Spinal anesthesia for noncardiac surgery in infants with congenital heart diseases

Spinal anesthesia for noncardiac surgery in infants with congenital heart diseases

Anesthetic management of noncardiac surgery for patients with single ventricle physiology

Spinal Anesthesia for Urologic Surgery in an Infant With Palliated Single Ventricle Physiology

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