title: Anesthesia for ventricular assist device placement in pediatric patients: experience from a single center.
abstract: BACKGROUND
  The use of a ventricular assist device (VAD) as a bridge to heart transplantation in the pediatric population has evolved over the past decades This article presents our institution's clinical experience in the anesthetic management of pediatric patients with end-stage heart failure who underwent implantation of a VAD between June 2009 and August 2012.
  
  
  METHODS
  Between February 2011 and August 2012, implantation of a VAD was performed in 10 children of mean age 8.6 years. This retrospective review analyzed their perioperative anesthetic care.
  
  
  RESULTS
  All patients had end-stage heart failure due to dilated cardiomyopathy. We used invasive arterial and central venous pressure monitoring and intraoperative transesophageal echocardiography in conjunction with intravenous administration of either ketamine (1 mg/kg) and midazolam (n = 3) or thiopental (3-5 mg/kg; n = 7). The mean intraoperative fentanyl dose was 434 ± 264.27 μg. Anesthesia was maintained with sevoflurane. Dopamine, dobutamine, and epinephrine were infused in 8, 10, and 5 patients, respectively. Inhaled nitric oxide was administered to all patients. The amounts of perioperative blood, fresh frozen plasma, and thrombocyte suspension transfusions were be 2.3 ± 0.82 (range, 1-4), 1.6 ± 0.69 (range, 1-3), and 2.4 ± 1.42 (range, 0-4) units, respectively. On average, patients were extubated 23 hours after arrival in the intensive care unit and exited there on day 6. Six patients were successfully bridged to heart transplantation, 2 died during the follow-up, and 2 patients remain on VAD support.
  
  
  CONCLUSIONS
  VAD is increasingly being used as a bridge to heart transplantation in the pediatric population. Anesthesiologists must be vigilant about the pathophysiology of heart failure, the operative procedure, and the implanted device.
authors.affiliation: Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, Izmir, Turkey. seden.kocabas@ege.edu.tr
authors.forename: S
authors.initials: S
authors.lastname: Kocabas
authors.forename: F Z
authors.initials: FZ
authors.lastname: Askar
authors.forename: T
authors.initials: T
authors.lastname: Yagdi
authors.forename: C
authors.initials: C
authors.lastname: Engin
authors.forename: M
authors.initials: M
authors.lastname: Ozbaran
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male