Anesthetic management in the arterial switch "jatene" operation for transposition of the great arteries.
The arterial switch "Jatene" operation for transposition of the great arteries (TGA) is an anatomic reconstruction at the level of the great arteries with reimplantation of the coronary arteries. The anesthetic management of 46 patients who underwent the Jatene operation between 1982 and 1985 was retrospectively reviewed. The mean age was 12.3 +/- 11.2 months (youngest: 4 days) and the mean body weight was 7.0 +/- 2.8 kg (smallest: 3.0 kg). Anesthesia was induced with ketamine in 35 patients, and maintained with morphine in 36 patients. Catecholamine (CA) drugs were given to 10 patients before cardiopulmonary bypass (CPB) and to all patients after CPB. In addition, nitroglycerin (NTG) was given to 13 patients during and after CPB. Platelets were given to prevent bleeding due to platelet damage caused by CPB. Six patients died, producing a mortality rate of 13%. Body weight, age, anesthetic agent, dose of CA, volume of blood loss, and duration of aortic cross-clamping, anesthesia, and operation were not significantly related to the deaths. Urinary output was significantly smaller (P < .05) in the patients who died. The LV/RV pressure ratio was as low as 0.625 and 0.645 in two of six deaths due to left ventricular hypoplasia. Severe pulmonary hypertension occurred in the postoperative period in two patients, and two patients had heart failure following a previous operation for coarctation or interruption of the aorta. Since hypotension during induction is detrimental in these cases, ketamine was commonly used as an induction agent. Morphine was chosen rather than fentanyl to avoid bradycardia. Administration of CA drugs produced an inotropic effect on the heart, and NTG helped maintain coronary blood flow and prevented pulmonary hypertension. There were no anesthetic deaths as judged by both the surgeons and anesthesiologists.
Takada
K
K
Department of Anesthesiology, Tokyo Women's Medical College, 8-1 Kawada-cho Shinjuku-ku Tokyo 162, Japan.
Fujita
M
M
Satoh
M
M
Sohma
N
N
Shiina
K
K
Nomura
M
M
Nishiyama
K
K
Shirai
K
K
Kurosawa
H
H
Imai
Y
Y
D000759:Adjuvants, Anesthesia; D000768:Anesthesia, General; D002315:Cardiopulmonary Bypass; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D002395:Catecholamines / Q000008:administration & dosage*; D002675:Child, Preschool; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007022:Hypotension / Q000517:prevention & control; D007223:Infant; D007231:Infant, Newborn; D008991:Monitoring, Physiologic; D005996:Nitroglycerin / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D014665:Vasodilator Agents / Q000627:therapeutic use
D000759:Adjuvants, Anesthesia; D002395:Catecholamines; D014665:Vasodilator Agents; D005996:Nitroglycerin