Anesthesia for noncardiac procedures for children with a Berlin Heart EXCOR (R) Pediatric Ventricular Assist Device: A case series

Cave, Dominic A., Fry, Kathryn M. and Buchholz, Holger (2010) Anesthesia for noncardiac procedures for children with a Berlin Heart EXCOR (R) Pediatric Ventricular Assist Device: A case series. Pediatric Anesthesia, 20 7: 647-659. doi:10.1111/j.1460-9592.2010.03314.x


Author Cave, Dominic A.
Fry, Kathryn M.
Buchholz, Holger
Title Anesthesia for noncardiac procedures for children with a Berlin Heart EXCOR (R) Pediatric Ventricular Assist Device: A case series
Formatted title
Anesthesia for noncardiac procedures for children with a Berlin Heart EXCOR ®Pediatric Ventricular Assist Device: A case series
Journal name Pediatric Anesthesia   Check publisher's open access policy
ISSN 1155-5645
1460-9592
Publication date 2010-07
Sub-type Article (original research)
DOI 10.1111/j.1460-9592.2010.03314.x
Volume 20
Issue 7
Start page 647
End page 659
Total pages 13
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2011
Language eng
Formatted abstract
Objectives: To report our experience of providing anesthesia for
noncardiac procedures in children with in situ Berlin Heart EXCOR
Pediatric® ventricular assist devices and to suggest principles of
anesthetic management.
Background: With the initiation of the first North American training
and support center for Berlin Heart at our institution in 2006, we have
been asked to provide anesthesia for noncardiac procedures to these
children. No current anesthetic approach to these children has been
reported.
Methods ⁄ Materials: Anesthetic records for all noncardiac procedures
for children with Berlin Heart between August 2006 and February
2009 in a tertiary care pediatric hospital were retrospectively
reviewed. Charts were reviewed for demographic and clinical data,
perioperative management, and occurrence of hypotension.
Results: Twenty-nine procedures were performed on 11 patients.
Hypotension was a common occurrence with all anesthetic induction
and maintenance agents even at low doses. Ketamine induction,
however, was less likely to produce hypotension, odds ratio for
hypotension 0.1333 (95% confidence range 0.021–0.856). Hypotension
was responsive to fluid bolus (60%) and alpha-receptor agonists
(100%). Preoperative stability and presence of biventricular ventricular
assist device (BiVAD) did not predict intraoperative hemodynamic
course.
Conclusions: Unlike patients with other ventricular assist devices,
these children do not tolerate reductions in systemic vascular
resistance (SVR) because of the relatively fixed cardiac output of this
device. Agents that reduce SVR should be avoided where possible.
Preoperative stability is not predictive. Fluids and alpha-agonists
should be first-line response to hypotension in this population.
© 2010 Blackwell Publishing Ltd.
Keyword Pediatric anesthesia
Ventricular assist
Berlin Heart
Perioperative
Hypotension
Ketamine
Remifentanil
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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Created: Sun, 19 Sep 2010, 00:03:09 EST