Summary
Background: Pulmonary arterial hypertension (PAH) is associated with significant perioperative risk for major complications in children, including pulmonary hypertensive crisis and cardiac arrest. Uncertainty remains about the safety of ketamine anesthesia in this patient population.
Aim: Retrospectively review the medical records of children with PAH to ascertain the nature and frequency of peri-procedural complications and to determine whether ketamine administration was associated with peri-procedural complications.
Methods: Children with PAH (mean pulmonary artery pressure ≥25 mmHg and pulmonary vascular resistance index ≥3 Wood units) who underwent general anesthesia for procedures during a 6-year period (2002–2008) were enrolled. Details about the patient, PAH, procedure, anesthetic and postprocedural course were noted, including adverse events during or within 48 h of the procedure. Complication rates were reported per procedure. Association between ketamine and peri-procedural complications was tested.
Results: Sixty-eight children (median age 7.3 year, median weight 22 kg) underwent 192 procedures. Severity of PAH was mild (23%), moderate (37%), and severe (40%). Procedures undertaken were major surgery (n = 20), minor surgery (n = 27), cardiac catheterization (n = 128) and nonsurgical procedures (n = 17). Ketamine was administered during 149 procedures. Twenty minor and nine major complications were noted. Incidence of cardiac arrest was 0.78% for cardiac catheterization procedures, 10% for major surgical procedures and 1.6% for all procedures. There was no procedure-related mortality. Ketamine administration was not associated with increased complications.
Conclusions: Ketamine appears to be a safe anesthetic option for children with PAH. We report rates for cardiopulmonary resuscitation and mortality that are more favorable than those previously reported.
#1Brenda MacKnight(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 1
#2Elizabeth A. Martinez(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 29
Last. Brett A. Simon(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 32
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Advances in the treatment of patients with chronic pulmonary hypertension have greatly improved their functional status and longevity, and increasing numbers of these complex patients are presenting for elective noncardiac surgery. In this communication we will briefly review the classification and pathophysiology of pulmonary hypertension, summarize outpatient pharmacotherapy approaches, and discuss the perioperative preparation and management of these complex patients. With an understanding of...
Summary Pulmonary arterial hypertension (PAH) is associated with significant perioperative risk for major complications, including pulmonary hypertensive crisis and cardiac arrest. Several mechanisms of hemodynamic deterioration, including acute increases in pulmonary vascular resistance (PVR), alterations of ventricular contractility and function and coronary hypoperfusion can contribute to morbidity. Anesthetic drugs exert a variety of effects on PVR, some of which are beneficial and some unde...
BACKGROUND:The use of ketamine in children with increased pulmonary vascular resistance is controversial. In this prospective, open label study, we evaluated the hemodynamic responses to ketamine in children with pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg).METHODS:Children aged
Background Children with primary pulmonary hypertension (PHT) are a high‐risk group who require assessment by cardiac catheterization under anaesthesia. Complications, including death, have occurred during anaesthesia in these patients, but the true risk has not been quantified. Methods The clinical records of children with PHT undergoing general anaesthesia for pulmonary vascular resistance studies were reviewed retrospectively. Data collected included pre-catheter measures of severity of disea...
Pulmonary arterial hypertension (PAH) is defined as the presence of a mean pulmonary artery pressure (PAP) that exceeds 25 mm Hg at rest or 30 mm Hg during exercise. PAH can be idiopathic (primary) or associated with a variety of underlying causes (1–3). Patients with PAH are generally considered to be at greater risk for the development of life-threatening perioperative cardiovascular complications. Increases in pulmonary vascular resistance (PVR) will increase right ventricular afterload, and ...
Objective: To determine the importance of the mean arterial pressure-to-mean pulmonary artery pressure ratio (MAP/MPAP) in cardiac surgical patients. Design: Retrospective and prospective studies (3 groups). Setting: Tertiary care hospital. Participants: Cardiac surgical patients (1,557). Intervention: Retrospective analysis (group 1), induction of general anesthesia (group 2), and transesophageal Doppler echocardiography (group 3). Measurements and Main Results: In group 1 (n = 1,439), demograp...
Idiopathic pulmonary arterial hypertension is a rare and potentially fatal condition. Without treatment, survival is only approximately 2.8 years from diagnosis. However, if the pulmonary hypertension is secondary to other causes, especially to congenital heart disease, it is possible to survive for 30 years or more without treatment. In recent years, remarkable progress has been made, risk factors have been identified and improved imaging techniques, including echocardiography, computer tomogra...
Summary Background: Cardiac catheterization has revolutionized the management of pediatric cardiac disease. There has been little information on adverse events during these cases from an anesthesia viewpoint. The aim of this audit was to determine the incident rate during pediatric cardiac catheterization as contemporaneously reported by the anesthetist and to identify both the types of events and which procedures had the highest risk. Methods: Since 1993, data have been collected prospectively ...
Objectives We sought to determine the predictors of short-term morbidity and mortality ( Background Pulmonary hypertension is considered to be a significant preoperative risk factor. Methods The PH and surgical data bases were matched from 1991 to 2003. Patients were excluded if PH was secondary to left heart disease, not present before surgery, or the procedure involved cardiopulmonary bypass. Univariate and multivariate logistic regression analyses were used to identify variables associated wi...
Pulmonary hypertension is a significant complication in many paediatric disease states. This article discusses current understanding of pulmonary hypertension and includes definition, diagnosis, and management. A description of the latest advances in targeted pharmacological therapy in children is also provided as well as impact on morbidity and mortality.
Neonates represent a unique subset of the pediatric population that requires special attention and careful thought when implementing advanced cross-sectional imaging with CT or MRI. The ionizing radiation associated with CT and the sedation/anesthesia occasionally required for MRI present risks that must be balanced against the perceived benefit of the imaging examination in the unique and particularly susceptible neonatal population. We review the perceived risks of ionizing radiation and the m...
Pulmonary hypertension (PH) can lead to progressive heart failure with high morbidity and mortality. Cardiac catheterization (CC) is the gold standard for diagnosis and response to vasodilatory medications. The invasive nature of CC and associated anesthesia predispose this patient population to adverse events including death. Catheterization records were queried from 1/1/2011 to 10/31/2016. Patients with PH, defined as pulmonary vascular resistance (PVR) greater than 3 WU m2, pulmonary artery p...
#2Timur Meşe(UHSA: University of Health Sciences Antigua)
Background This study aims to evaluate the frequency of and associated risk factors for adverse events caused by cardiac catheterization procedures in pediatric patients. Methods Between January 2009 and January 2012, a total of 599 pediatric patients (320 males, 279 females; mean age 5.4±4.7 years; range, 1 day to 21 years) who underwent cardiac catheterization in our cardiac catheterization laboratory were retrospectively analyzed. Demographic and clinical data of the patients including the du...
Resumo Introducao: Varios procedimentos de cardiologia intervencionista sao necessarios em neonatos com doenca cardiaca congenita. Os procedimentos de cardiologia intervencionista tem um risco maior de parada cardiaca em comparacao com outras intervencoes. Atualmente, ha grande heterogeneidade no manejo perioperatorio de neonatos com doenca cardiaca congenita submetidos a cateterismo cardiaco diagnostico ou cateterismo cardiaco terapeutico. Objetivo: Objetivo principal: fornecer uma revisao sist...
Abstract Background Several interventional cardiology procedures are required in neonates with congenital heart disease. Interventional cardiology procedures have a higher risk of cardiac arrest compared to other interventions. At present, there is great heterogeneity in the perioperative management of congenital heart disease neonates undergoing diagnostic cardiac catheterization or therapeutic cardiac catheterization. Study objectives Primary aim: Provide a systematic review of the most effect...
Transthoracic echocardiogram (TTE) is commonly used to screen for pulmonary hypertension (PHTN) in neonates and young infants. However, in the absence of sufficient tricuspid regurgitation (TR), a ventricular septal defect (VSD), or a patent ductus arteriosus (PDA), the estimation of systolic pulmonary artery pressure (SPAP) becomes challenging. Pulmonary artery acceleration time (PAAT) is an alternate parameter that is easy to obtain in almost all patients and does not require the presence of t...
#2Delphine Yung(UW: University of Washington)H-Index: 12
: Pediatric pulmonary hypertension is a complex disease with multiple, diverse etiologies affecting the premature neonate to the young adult. Pediatric pulmonary arterial hypertension, whether idiopathic or associated with congenital heart disease, is the most commonly discussed form of pediatric pulmonary hypertension, as it is progressive and lethal. However, neonatal forms of pulmonary hypertension are vastly more frequent, and while most cases are transient, the risk of morbidity and mortali...
Abstract The last several decades have seen remarkable advances in medical and surgical care of children with congenital heart disease (CHD). This progress has resulted in decreased morbidity and overall improvements in long-term clinical outcomes. As survival rates continue to improve, an escalating number of affected children will present for noncardiac surgery or other procedures unrelated to their heart disease. The care of these children is becoming more common in all diagnostic and surgica...
Pulmonary hypertension is a significant medical condition, with a global prevalence estimated as high as 1%. As such, it is no longer an uncommon occurrence for patients with pulmonary hypertension to present for surgery. Pulmonary resection in the patient with pulmonary hypertension has long been considered high risk and discouraged in early literature. The morbidity and mortality associated with pulmonary hypertension in patients presenting for surgery have been quoted as high as 42% and 18%, ...
