The Pediatric Cardiac Anesthesia Handbook / Edition 1 available in Paperback, eBook
The Pediatric Cardiac Anesthesia Handbook / Edition 1
- ISBN-10:
- 1119095530
- ISBN-13:
- 9781119095538
- Pub. Date:
- 04/24/2017
- Publisher:
- Wiley
The Pediatric Cardiac Anesthesia Handbook / Edition 1
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$107.95Overview
Written by an expert author team at the renowned Boston Children's Hospital, USA, The Pediatric Cardiac Anesthesia Handbook provides a comprehensive yet concise overview of the anesthetic management of pediatric patients with congenital heart disease.
This book is divided into two parts. The first part provides an introduction to the basic assessment of patients, including cardiovascular physiology, pathophysiology and the underlying concepts in coronary heart disease, preoperative evaluation, intraoperative management, and interpretation of cardiac catheterization data. The second part of the book addresses disorders and diseases in a templated manner covering the anatomical and physiological features, surgical therapies, anesthetic approach and postoperative management. Chapters on the heart and heart and lung transplantation consider the additional complexities of those patients and anesthetic considerations for non-cardiac surgery after heart transplantation.
The anesthesiologist caring for patients with congenital heart disease faces a myriad of challenges in the perioperative management of these complex individuals. This book provides:
- A concise and easily referable guide ideal for use during anesthesiology residency training and fellowships.
- A templated chapter layout ideal for easy referral by wider members of the multidisciplinary team, such as cardiologists, cardiac intensivists, perfusionists, and surgeons.
- Helpful illustrations and a bulleted content for rapid reference.
- Guidelines on specific lesions for the pediatric anesthesiologist caring for cardiac patients presenting for non-cardiac surgery.
This book is a valuable resource for all anesthesiology and cardiac critical care providers who manage patients with congenital heart disease, and an ideal study aid.
Product Details
| ISBN-13: | 9781119095538 |
|---|---|
| Publisher: | Wiley |
| Publication date: | 04/24/2017 |
| Pages: | 288 |
| Sales rank: | 737,949 |
| Product dimensions: | 7.00(w) x 9.90(h) x 0.60(d) |
About the Author
Viviane G. Nasr, MD graduated from Medical School at the American University of Beirut (AUB), Lebanon in 2003, and pursued a residency in anesthesiology at AUB and Tufts Medical Center, Boston. She completed a pediatric anesthesia fellowship at Children's National Medical Center (CNMC) in Washington DC and a pediatric cardiac anesthesia fellowship at Boston Children's Hospital. She is American Board certified in Anesthesiology and Pediatric Anesthesiology and an active member of the Congenital Cardiac Anesthesia Society.
James A. DiNardo, MD graduated from Dartmouth College and Dartmouth Medical School (with honors). He completed his anesthesia residency and fellowship in Cardiac Anesthesia at Beth Israel Hospital in Boston. He joined faculty at Boston Children's Hospital in 1999 where he currently serves as the Chief of the Division of Cardiac Anesthesia. He spends approximately one third of this clinical time as an Attending in the Cardiac ICU.Dr DiNardo is certified in perioperative TEE and is former Chairman of the PTEeXAM Committee. He is also a Senior Oral Board Examiner for the ABA, a member of the ABA Pediatric Examination Writing Committee, and Chair of the Pediatric MOCA Examination Committee. He is Past-President of both the Congenital Cardiac Anesthesia Society and the Association of Cardiac Anesthesiologists. He is currently the Anesthesia and Analgesia Executive Editor for Pediatric Anesthesia.He is the author of a major textbook on cardiac anesthesia and of more than 160 peer-reviewed articles and book chapters.
Read an Excerpt
Table of Contents
Preface xvii
Part I The Basics 1
1 Cardiovascular Development 3
Embryology 3
Cardiovascular Physiology 3
Fetal Circulation 3
Closure of the Ductus Arteriosus 5
Closure of the Foramen Ovale 6
Closure of the Ductus Venosus 6
Pulmonary Vascular Changes 6
Myocardial Performance in the Neonate 7
Hemodynamic Changes at Birth 7
2 Important Concepts in Congenital Heart Disease 9
Pathophysiology of CHD 9
Concepts of Shunting, Single‐Ventricle Physiology, and Inter‐Circulatory Mixing 9
Shunting 9
Effective Blood Flow 10
Total Pulmonary Blood Flow/Total Systemic Blood Flow 10
Single‐Ventricle Physiology 10
Intercirculatory Mixing 13
Classification of Anatomic Shunts 15
Simple Shunts 15
Complex Shunts 15
Pulmonary Vascular Pathophysiology 18
Causes of Pre‐Capillary PH in CHD 18
Causes of Post‐Capillary PH in CHD 18
Control of Pulmonary Vascular Resistance 19
PaO2 19
PaCO2 19
pH 19
Variation in Lung Volumes 19
Vasodilator Agents 20
Sympathetic Nervous System Stimulation 20
Myocardial Ischemia 21
Aortic Diastolic Pressure 21
Subendocardial Pressure 21
Heart Rate 22
Anatomic Coronary Artery Lesions 22
3 Preoperative Evaluation 23
Clinical History 23
Physical Examination 23
Associated Congenital Abnormalities 24
Laboratory Data 25
Pregnancy 26
Psychological Considerations 26
Preoperative Preparation 27
Preoperative Fluid Therapy 27
Preoperative Medications 29
4 Intraoperative Management 31
Intraoperative Monitoring 31
ECG and Blood Pressure 31
Systemic Oxygen Saturation 32
End‐Tidal CO2 32
Central Venous Pressure 32
Temperature 33
Near‐Infra‐Red Spectroscopy 33
Transcranial Doppler 34
Transesophageal Echocardiography (TEE) 35
Airway Management 35
Anesthesia Induction and Maintenance 36
Induction of Anesthesia 36
Mask Induction 36
Intravenous Induction 36
Maintenance of Anesthesia 37
5 Interpretation of Cardiac Catheterization Data 39
Right‐Heart Catheterization 39
Right Atrial Pressure (RAP) Waveform 39
Right Ventricular Pressure (RVP) Waveform 39
Pulmonary Artery Pressure (PAP) Waveform 40
Left‐Heart Catheterization 40
Left Atrial Pressure (LAP) Waveform 41
Left Ventricular Pressure (LVP) Waveform 41
Aortic Pressure Waveform 41
Left Ventriculography 41
Coronary Angiography 43
Coronary Anatomy 43
Anatomic Coronary Lesions 44
Coronary Collaterals 45
Cardiac Output Determination 45
Thermodilution Technique 45
Fick Determination 45
Evaluation of Cardiac Shunts 46
Shunt Location 46
Shunt Quantification 46
Saturation Data 48
Resistances 48
Assessment of Pulmonary Vascular Anatomy 48
Evaluation of the Pulmonary Vasculature 48
Pulmonary Artery Wedge Angiogram 48
Pulmonary Vein Wedge Angiogram 49
Assessment of Pulmonary Arterial Hypertension 49
Assessment of Valve Lesions 50
Stenotic Lesions 50
Regurgitant Lesions 50
6 Cardiopulmonary Bypass 51
The Cardiopulmonary Bypass Circuit 51
Differences Between Adult and Pediatric CPB 53
CPB Flow Rates 53
Anesthesia During CPB 53
Monitoring During CPB 54
Hemodilution 54
Priming Solution 54
Ultrafiltration 55
Conventional Ultrafiltration 55
Modified Ultrafiltration 55
Blood Gas Management 55
Deep Hypothermic Circulatory Arrest and Regional Perfusion Techniques 57
Anticoagulation 57
Protamine Reversal 58
7 Mechanical Support Devices 59
Extracorporeal Membrane Oxygenation (ECMO) 59
Indications 59
Relative Contraindications 59
Modes of ECMO Support 59
Veno‐Venous (VV)‐ECMO 59
Veno‐Arterial (VA)‐ECMO 59
Device and Patient Complications 60
Common Terminology Used During an ECMO Run 61
Intraoperative Considerations for Patients on ECMO 61
Ventricular Assist Devices (VADs) 62
Indications 62
Relative Contraindications 62
Modes of VADs 62
Complications 62
Anesthetic Considerations for Patients Receiving VAD 62
Induction of Anesthesia and Pre‐Bypass Management 64
Post‐VAD Placement Management 65
BiVAD Insertion 65
Part II Specific Lesions 67
8 Patent Ductus Arteriosus 69
Introduction 69
Anatomy 69
Physiology 69
Surgical Therapy 69
Catheterization Laboratory Intervention 70
Anesthetic Management 70
Induction and Maintenance 70
Non‐Cardiac Surgery 71
9 Aortopulmonary Window 73
Introduction 73
Anatomy 73
Physiology 73
Surgical Management 73
Catheterization Laboratory Intervention 74
Anesthetic Management 75
Non‐Cardiac Surgery 75
10 Coarctation of the Aorta 77
Introduction 77
Anatomy 77
Physiology 77
Surgical Therapy 80
Catheterization Laboratory Intervention 80
Anesthetic Management 81
Induction and Maintenance 81
Management after Cross‐Clamp Removal 82
Non‐Cardiac Surgery 82
11 Atrial Septal Defect 83
Introduction 83
Anatomy 83
Ostium Secundum ASD 83
Ostium Primum ASD 83
Sinus Venosus Defects 84
Coronary Sinus Defect 84
Physiology 85
Surgical Therapy 85
Catheterization Laboratory Intervention 85
Anesthetic Management 86
Induction and Maintenance 86
Post‐CPB Management 86
Non‐Cardiac Surgery 87
12 Ventricular Septal Defect 89
Introduction 89
Anatomy 89
Subpulmonary or Supracristal Defects 89
Membranous or Perimembranous Defects 89
Conoventricular Defects 89
Inlet or Canal‐Type Defects 89
Muscular Defects 89
Physiology 89
Surgical Therapy 91
Catheterization Laboratory Intervention 91
Anesthetic Management 91
Induction and Maintenance 91
Post‐CPB Management 91
Non‐Cardiac Surgery 92
13 Atrioventricular Canal Defects 93
Introduction 93
Anatomy 93
Partial AVC 93
Transitional AVC 93
Complete AVC (CAVC) 93
Unbalanced AVC 94
Physiology 94
Surgical Therapy 95
Anesthetic Management 95
Induction and Maintenance 95
Post‐CPB Management 96
Non‐Cardiac Surgery 96
14 Double Outlet Right Ventricle 97
Introduction 97
Anatomy 97
Physiology 99
Surgical Therapy 100
Anesthetic Management 101
Induction and Maintenance 101
Post‐CPB Management 101
15 Truncus Arteriosus 103
Introduction 103
Anatomy 103
Physiology 104
Surgical Therapy 104
Catheterization Laboratory Intervention 105
Anesthetic Management 105
Goals 105
Induction and Maintenance 105
Post‐CPB Management 105
Goals 106
16 Total Anomalous Pulmonary Venous Return 107
Introduction 107
Anatomy 107
Physiology 108
Surgical Therapy 109
Anesthetic Management 109
Goals 109
Induction and Maintenance 110
Post‐CBP Management 110
Goals 110
Long‐Term Outcomes 110
17 Left Ventricular Outflow Tract Obstruction 113
Introduction 113
Anatomy 113
Physiology 113
Surgical Therapy 114
Catheterization Laboratory Intervention 114
Anesthetic Management 114
Goals 114
Induction and Maintenance 115
Post‐CPB Management 115
18 Mitral Valve 117
Mitral Valve Stenosis 117
Introduction 117
Anatomy 117
Physiology 118
Surgical Therapy 118
Catheterization Laboratory Intervention 118
Anesthetic Management 118
Goals 118
Pre‐Induction 119
Induction and Maintenance 119
Post‐Cardiopulmonary Bypass (CPB) Management 120
Mitral Valve Regurgitation 121
Introduction 121
Anatomy 121
Physiology 121
Surgical Management 122
Catheterization Laboratory Intervention 122
Anesthetic Management in Mitral Regurgitation 122
Goals 122
Premedication 122
Induction and Maintenance 122
Post‐CPB Management 123
19 Pulmonary Atresia/Intact Ventricular Septum (PA/IVS) 125
Introduction 125
Anatomy 125
Physiology 125
Surgical and Catheter‐Based Therapy 126
Anesthetic Management 129
Goals 129
Post‐CPB Management 129
20 Tetralogy of Fallot (TOF) 131
Introduction 131
Anatomy 131
Physiology 131
Hypoxic or Hypercyanotic Episodes (‘Tet Spells’) 132
Surgical Therapy 134
Palliative Shunts 134
Definitive Repair 136
Catheterization Laboratory Intervention 136
Anesthetic Management 137
Goals 137
Induction and Maintenance 137
Post‐CPB Management 138
Goals 138
Postoperative Junctional Ectopic Tachycardia 139
Non‐Cardiac Surgery 139
21 Tetralogy of Fallot with Pulmonary Atresia (TOF/PA) 141
Anatomy 141
Physiology 141
Surgical Therapy 141
Anesthetic Management 143
Post‐CPB Management 143
22 Tetralogy of Fallot with Absent Pulmonary Valve (TOF/APV) 145
Anatomy 145
Physiology 145
Surgical Therapy 146
Anesthetic Management 146
Post‐CPB Management 146
23 Transposition of the Great Arteries (TGA) 147
Introduction 147
Anatomy 147
Physiology 148
Surgical Therapy 151
Anatomic Repair or the Arterial (Jatene) Switch Procedure 151
Intra‐Atrial Physiologic Repair: Mustard and Senning Procedures 153
Rastelli, Lecompte, and Nikaidoh Procedures 154
Anesthetic Management 155
Goals 155
Induction and Maintenance 155
Post‐CPB Management 155
Goals 155
Non‐Cardiac Surgery 157
Congenitally Corrected Transposition of the Great Vessels 157
Introduction 157
Anatomy 157
Physiology 158
Surgical Management 158
Traditional Repair for C‐TGV 158
Double Switch Procedure and Atrial Switch‐Rastelli Procedures 158
24 Single‐Ventricle Lesions 161
Introduction 161
Physiology and Initial Procedures 161
Initial Procedures to Optimize Pulmonary Arterial Blood Flow 161
Initial Procedures to Optimize Pulmonary Venous Blood Flow 163
Initial Procedures to Optimize Systemic Blood Flow 163
Management of Single‐Ventricle Physiology 164
Anesthetic Management, Pre‐Initial Repair 166
Goals 166
Induction and Maintenance 167
Post‐CPB Management, Post‐Initial Repair 167
Goals 167
Single‐Ventricle Pathway, Superior Cavopulmonary Shunt or Bidirectional Glenn (BDG) 169
Anesthetic Management, Pre‐Superior Cavopulmonary Shunt 171
Goals 171
Induction and Maintenance 171
Post‐CPB Management, Post‐Superior Cavopulmonary Shunt 171
Goals 171
Definitive Repair: The Fontan Procedure or Total Cavopulmonary Connection (TCPC) 172
Fontan Physiology 172
Fenestrated Fontan 176
Anesthetic Management, Pre‐Fontan 176
Goals 176
Induction and Maintenance 177
Post‐CPB Management, Post‐Fontan Procedure 177
Goals 177
Non‐Cardiac Surgery 180
25 Hypoplastic Left Heart Syndrome 181
Introduction 181
Anatomy 181
Physiology 181
Surgical Therapy 182
Anesthetic Management 183
Goals 183
Post‐CPB Management 183
Biventricular Repair 184
The ‘Borderline’ Left Heart 184
The Left Heart Rehabilitation 184
Staged Left Ventricular Recruitment 184
Biventricular Conversion 185
Non‐Cardiac Surgery 185
26 Interrupted Aortic Arch 187
Introduction 187
Anatomy 187
Physiology 187
Surgical Management 189
Catheterization Laboratory Intervention 189
Anesthetic Management 190
Goals 190
Induction and Maintenance 190
Post‐CPB Management 190
Goals 190
27 Vascular Rings 191
Introduction 191
Anatomy 191
Physiology 191
Surgical Management 191
Catheterization Laboratory Intervention 192
Anesthetic Management 192
28 Tricuspid Atresia 195
Introduction 195
Anatomy 195
Physiology 195
Surgical Therapy 197
Anesthetic Management 197
Goals 197
29 Heart Transplantation 199
The Donor 199
Anesthetic Management of the Recipient 202
Preoperative Evaluation 202
Physical Examination 202
Premedication 202
Preinduction 202
Induction and Maintenance 203
Operative Procedure 205
Post‐CPB Management 207
Goals 207
Preparation for Termination of CPB 207
Impaired Systolic Function 207
Right Ventricular Afterload Mismatch 208
Sinus and Atrioventricular Node Dysfunction 208
Impaired Diastolic Function 208
Termination of CPB 209
Non‐Cardiac Surgery in the Post‐Cardiac Transplant Patient 210
Physiology of the Transplanted Heart 210
Autonomic Nervous System 210
Heart Rate 210
Left Ventricular Systolic Function 211
Right Ventricular Systolic Function 211
Atrial Function 211
Diastolic Function 211
Issues Unique to Heart Transplant Patients 211
Cardiac Allograft Vasculopathy (CAV) 212
Hypertension 212
Atrial and Ventricular Arrhythmias 212
Subacute Bacterial Endocarditis (SBE) Prophylaxis 213
Rejection 213
Response to Drugs 213
Anesthetic Considerations for Non‐Cardiac Surgery in Patients Post Heart Transplantation 215
30 Heart–Lung and Lung Transplantation 217
Introduction 217
Single‐Lung Transplantation 217
Double‐Lung Transplantation 217
Living Donor Lobar Lung Transplant (LDLLT) 218
The Donor 218
Operative Procedure and Patient Positioning 219
Use of CPB 220
HLT and En‐Bloc DLT 220
SLT and BSSLT 220
Anesthetic Management 221
Goals 221
Preoperative Evaluation 221
Premedication 221
Preinduction 221
Management of One Lung Ventilation (OLV) 222
Endobronchial Intubation 222
Single‐Lumen Endotracheal Tube Plus a Bronchial Blocker 222
Single‐Lumen Endotracheal Tube Plus an E‐Z Bronchial Blocker 222
Univent Tube 222
Double‐Lumen Endotracheal Tube 224
Induction and Maintenance 224
Special Considerations for SLT and BSSLT 225
One‐Lung Ventilation 225
Clamping of the PA 226
Allograft Implantation 226
Indications for CPB 226
Post‐CPB Management 227
Postoperative Care 227
Non‐Cardiac Surgery in Lung Transplant Patients 227
Anesthetic Considerations for Non‐Cardiac Surgery in Patients Post Lung Transplantation 229
31 Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) 231
Introduction 231
Anatomy 231
Physiology 231
Surgical Treatment 231
Anesthetic Management 232
32 Heterotaxy 233
Introduction 233
Anatomy 233
Position of the Heart in the Chest 233
Atrial Anatomy 233
Venoatrial Connections 233
Ventricular Anatomy 234
Atrioventricular Junction 236
Ventriculoarterial Connections 236
Surgical Therapy 238
33 Ebstein Anomaly 239
Introduction 239
Anatomy 239
Physiology 239
Surgical Treatment 240
Anesthetic Management in Ebstein Anomaly 241
Goals 241
Post‐CPB Management 242
Index 243