Anesthetic considerations during caval inflow occlusion in children with congenital heart disease.
OBJECTIVE
Caval inflow occlusion (IO) was introduced to facilitate surgical pulmonary and aortic valvotomy without cardiopulmonary bypass (CPB). Although a technique that is used infrequently today, it remains useful in some patients with complex single-ventricle congenital cardiac defects who require an atrial septectomy. The potential for complications and anesthetic considerations have not been described previously.


METHODS
Retrospective review.


METHODS
A tertiary care university teaching children's hospital.


METHODS
Eleven children, median age 3 months (range 3 days-3 years) who underwent (IO) technique for atrial septectomy.


METHODS
Atrial septectomy under IO in patients with restrictive atrial septum.


RESULTS
Eleven children, median age 3 months (range 3 days-3 years), underwent IO for atrial septectomy. Mean duration of IO was 87.7 +/- 25.5 seconds. There was 1 intraoperative death (9%). After release of the caval clamps, inotropic support was necessary in 7 of 11 patients, arrhythmias occurred in 4 of 11 patients (2 atrial and 2 ventricular fibrillation), and 10 of 11 patients required blood transfusion along with boluses of calcium gluconate and sodium bicarbonate to support the circulation immediately post-IO. Duration of postoperative mechanical ventilation was 2.2 +/- 1.6 days; 10 of 11 patients (91%) survived to discharge with mean length of intensive care unit stay 3.7 +/- 2.2 days.


CONCLUSIONS
IO is an effective technique for short intracardiac procedures without the need for CPB. Close collaboration between anesthesia and surgical staff is essential to keep the duration of IO as short as possible and because of the potential for hemodynamic instability.
Odegard
Kirsten C
KC
Department of Anesthesia, Children's Hospital, Boston, MA 02115, USA. kristen.odegard@tch.harvard.edu
Schure
Annette
A
Saiki
Yoshikatsu
Y
Hansen
Dolly D
DD
Jonas
Richard A
RA
Laussen
Peter C
PC
D000768:Anesthesia, General / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D002675:Child, Preschool; D003250:Constriction; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006330:Heart Defects, Congenital / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods; D007530:Isoflurane / Q000627:therapeutic use; D008297:Male; D008488:Medical Illustration; D008874:Midazolam / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D010197:Pancuronium / Q000627:therapeutic use; D011651:Pulmonary Artery / Q000601:surgery; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D014684:Venae Cavae / Q000601:surgery*
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D007530:Isoflurane; D010197:Pancuronium; D008874:Midazolam; D005283:Fentanyl