Pediatric Cardiac Anesthesia

802 Pages·2004·8.92 MB·English

by  Carol L. Lake

Pediatric
Cardiac
Anesthesia
FOURTH EDITION

Pediatric
Cardiac
Anesthesia
FOURTH EDITION
E
DITORS
Carol L. Lake, MD, MBA, MPH
Former Professor and Chair
Department of Anesthesiology and Perioperative Medicine
University of Louisville
Louisville, Kentucky
Peter D. Booker, MB, BS, MD, FRCA
Senior Lecturer in Paediatric Anaesthesia
University of Liverpool
Honorary Consultant Paediatric Anaesthetist
Royal Liverpool Children’s Hospital
Liverpool, United Kingdom
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Pediatriccardiacanesthesia/editors,CarolL.Lake,PeterD.Booker.—4thed.
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Includesbibliographicalreferencesandindex.
ISBN0-7817-5175-6
1.Pediatricanesthesia.2.Pediatriccardiology.3.Congenitalheartdiseasein
children—Surgery.
[DNLM:1.HeartDefects,Congenital—surgery.2.Anesthesia—Child.3.
Anesthesia—Infant.4.IntraoperativeCare—Child.5.IntraoperativeCare—Infant.WS290
P370172005]I.Lake,CarolL.II.Booker,PeterD.
RD139.P432005
617.9’67412’0083—dc22
2004023923
Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentedandtodescribe
generallyacceptedpractices.However,theauthors,editors,andpublisherarenotresponsible
forerrorsoromissionsorforanyconsequencesfromapplicationoftheinformationinthis
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oraccuracyofthecontentsofthepublication.Applicationofthisinformationinaparticular
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109876543
P R E F A C E
P sectionofeightchaptersexpoundstheprinciplesofin-
traoperativeanestheticcare;monitoring;cardiopulmo-
ediatric Cardiac Anesthesia, Fourth Edition, pro-
narybypass,includingprofoundhypothermiaandcir-
vides a comprehensive review of the anesthetic and
culatory arrest, organ preservation, hemostasis, and
perioperativemanagementofpatientswithcongenital
postbypass cardiopulmonary dysfunction. The fifth
cardiac anomalies of all types. Research in pediatric
sectionprovidesupdatedandexpandedsystematicde-
cardiacanesthesia,cardiology,andcardiacsurgeryhas
scriptionsof thediagnostic features,pathophysiology,
advanced dramatically in the fourteen years since the
natural history, anesthetic techniques, surgical thera-
firstedition,particularlyinthefiveyearssincethethird
peuticoptions,immediatepostoperativecare,andlong-
edition, accordingly, new chapters have been added.
term outcomes for the major cardiac conditions. New
Manynewauthorshavebeenaddedtoprovideaninter-
tothesechaptersisinformationoncortriatriatum,hy-
nationalapproachtopediatriccardiacanesthesia,and
poplastic right heart syndromes, unifocalization, and
to include such areas as the teaching of pediatric car-
techniques for managing hypoplastic left heart syn-
diacanesthesiaandtheassessmentofqualityinpediat-
drome,amongothers.Allchaptersonindividuallesions
ric cardiac care. A major change is the addition of a
havebeenextensivelyupdatedorcompletelyrewritten,
co-editorfromtheUnitedKingdom,withtheintentof
aprocessthathasbeenhelpedbytheadditionoftwelve
creatingaworkthatisinternationalinscopeandprac-
newauthors.Thesinglepagesynopsesofperioperative
tice.
managementofeachcardiaclesionhavebeenretained
Likethethirdedition,thefourtheditionbeginswith
fromtheprioredition.Thesixthsectionpresentsadis-
an historical perspective. This opening chapter con-
cussion of postoperative care. This section is followed
cludes with thoughts on the future of the specialty,
by the concluding section on practice management.
whichisanticipatedtoincludefurtherdevelopmentof
Thefourtheditionshouldbeofinteresttopediatric
minimally invasive surgery, improved interventional
and cardiac anesthesiologists at the resident, senior
catheterizationtechniques, andfetalsurgery. Thesec-
houseofficer,fellow,orconsultantlevels;pediatriccar-
ond chapter providesan epidemiologic perspective on
diac surgeons and their trainees; pediatric cardiolo-
heart disease in children in developing countries. The
gists; specialists in pediatric critical care; as well as
secondsectionfocusesondevelopmentalissuesandin-
cludesthreechaptersthat concentrateonintrauterine medicalstudentsandnursesinvolvedinthecareofpe-
and extrauterine cardiovascular development, and the diatriccardiacpatients.Insummary,thefourthedition
effectsofanestheticandotherpharmacologicagentson of Pediatric Cardiac Anesthesia provides comprehen-
thedevelopingcardiovascularsystem.Thethirdsection sive, authoritative information about the pathophysi-
focuseson preoperativeevaluation includingechocar- ology, perioperative management, and postoperative
diography,electrocardiographyandelectrophysiology, outcome of patients with congenital heart disease
cardiac catheterization and other imaging examina- undergoing cardiac or noncardiac surgery as children
tions,andgeneralpreoperativepreparation.Thefourth or adults.
v

A C K N O W L E D G M E N T S
T pared by the staff of the Division of Biomedical Com-
munications at the University of Virginia Health
heeditorswishtothanktheauthorswhocontrib- SciencesCenterhavebeenincorporatedintotheFourth
utedtheirtimeandexpertiseinwritingtheirindividual Edition.Inaddition,numerousauthorsandpublishers
chapters on the care of pediatric patients before, dur- have kindly permitted us to reprint figures and tables
ing,andaftersurgeryforcongenitalheartdisease.We from their work.
particularlywishtothanktheauthorsofnewchapters Theeditorsaregratefultopediatricandanesthesiol-
onpediatriccardiacanesthesiaindevelopingcountries, ogyfacultiesfromuniversitiesintheUnitedStates,the
teachingpediatriccardiacanesthesia,andqualityman- United Kingdom, and other parts of the world, who
agement in pediatric cardiac surgery for their innova- havesharedtheirthoughtsandideasforthefourthedi-
tionsandcreativityinapproachingtheseareas.Asclini- tion. Finally, we wish to thank the staff of Lippincott
calresponsibilitieshaveincreasedinmostdepartments Williams & Wilkins, particularly Craig Percy and Sta-
around the world,the preparation of chaptersfor this cey Baze Sebring for their enthusiastic help in the
edition represents a most significant commitment to preparationofthemanuscriptandtheirunderstanding
thecontinualimprovementofcareforpediatriccardiac about the inevitable and unavoidable delays.
patients.
Muchoftheartwork,graphicdesign,andphotogra- Carol L. Lake, MD, MBA, MPH
phy from the first and second editions that were pre- Peter D. Booker, MB, BS, MD, FRCA
vii

C O N T E N T S
8.
Preface v Pediatric Electrocardiography and Cardiac
Acknowledgments vii Electrophysiology 137
ContributingAuthors xi Kevin P. Walsh
9.
ColorInsert Pediatric Echocardiography 151
Wyman W. Lai, H. Helen Ko, and Ira A.
Parness
SECTION I. INTRODUCTION 1
SECTION IV. PRINCIPLES OF
1. PEROPERATIVE MANAGEMENT 174
History of Pediatric Cardiac Anesthesia 1
Carol L. Lake
2.
Pediatric Heart Disease in the Developing
World 7 10. Anesthetic and Peroperative Management 174
Annette J.M. Davis Monica A. Stokes
11.
Monitoring of the Pediatric Cardiac
Patient 190
Carol L. Lake and Harvey L. Edmonds
SECTION II. DEVELOPMENTAL 12. Physiology and Techniques of
ISSUES 13 Extracorporeal Circulation in the Pediatric
Patient 228
James A. DiNardo
3. Intrauterine Development of the 13. Profound Hypothermia and Circulatory
Cardiovascular System 13 Arrest 253
Carol L. Lake James A. DiNardo
4. Extrauterine Development of the 14. Vital Organ Preservation During Surgery
Cardiovascular System 28 for Congenital Heart Disease 266
Peter D. Booker Emad B. Mossad and Ibrahim Farid
5. Pediatric Anesthesia Pharmacology 50 15. Management of Postbypass Myocardial
D. Ryan Cook, Peter J. Davis, and Richard Dysfunction 291
J. Ing Laurie K. Davies
16.
Hemostasis, Coagulation, and Transfusion
in the Pediatric Cardiac Patient 304
William C. Oliver Jr.
17.
SECTION III. PREOPERATIVE Management of Postbypass Pulmonary
EVALUATION 95 Hypertension and Respiratory Dysfunction 317
Angus McEwan
6.
Preoperative Evaluation and Preparation
of the Pediatric Patient with Cardiac
SECTION V. ANESTHESIA FOR
Disease 95
CARDIAC SURGICAL PROCEDURES 329
Ellise Delphin, Ali Inanc Sec¸kin, and Roger
A. Moore
7.
Cardiac Catheterization and Other
18.
Radiographic Examinations 112 Septal and Endocardial Cushion Defects 329
Ingrid Hollinger and Alexander Mittnacht Julie K. Hudson and Jayant K. Deshpande
ix
x Contents
19.
Tetralogy of Fallot 344 Children and Adults with Congenital Heart
William A. Lell and F. Bennett Pearce Disease 601
20.
Transposition of the Great Vessels 357 David Frankville
James A. DiNardo
21.
Anomalies of the Aortic Arch and Valve 381
David A. Rosen and Kathleen R. Rosen
22. SECTION VI. POSTOPERATIVE
Anomalies of the Pulmonary Valve and
Right Ventricular Outflow Tract 426 CARE 633
Ian Adatia and Helen Holtby
23.
Tricuspid Atresia 435
35.
Susan Tebich Postoperative Care: General Principles 633
24.
Hypoplastic Left Heart Syndrome 445 Peter D. Booker
36.
George M. Hoffman and Eckehard A.E. Postoperative Cardiovascular Dysfunction:
Stuth Pharmacologic Support 654
25. Double Outlet Right Ventricle 467 Peter D. Booker
37.
Postoperative Respiratory Function and Its
Julie K. Hudson and Jayant K. Deshpande
26. Management 682
Truncus Arteriosus 472
Lori A. Aronson and Catherine L. Dent
Ian M. McKenzie 38.
27. Renal, Gastrointestinal, Hepatic, and
Anomalies of Systemic and Pulmonary
Neurologic Dysfunction 705
Venous Return 480
Duncan J. Macrae
Carol L. Lake 39.
28. Postoperative Pain Management in the
Abnormalities of the Atrioventricular
Pediatric Cardiac Patient 723
Valves 501
Andrew R. Wolf
Victor C. Baum 40.
Anesthesia for Cardiac Procedures in the
29.
Coronary Artery Anomalies 523
Pediatric Intensive Care Unit 735
Monica A. Stokes
Annette J.M. Davis
30.
Cardiomyopathies 530
Ian M. McKenzie and Robert G. Weintraub
31.
Pulmonary Hypertension, Persistent Fetal
Circulation, and Eisenmenger Syndrome 536 SECTION VII. PRACTICE
Paul B. Baines and Andrew Selby MANAGEMENT 742
32.
Pediatric Cardiac and Lung
Transplantation 551
Linda J. Mason, Richard L. Applegate II, 41. Quality in Pediatric Cardiac Anesthesia 742
Teresa Thompson, and Michelle Kim D. Ryan Cook and Lisa Faberowski
33. Secondary Vascular Anomalies and 42. Teaching Pediatric Cardiac Anesthesiology 755
Cardiac Tumors 582 Chris Chin and Alan Jay Schwartz
Steven M. Auden
34.
Anesthesia for Noncardiac Surgery in Index 767