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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. CONCLUSION: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.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Kocabas S,Askar FZ,Yagdi T,Engin C,Ozbaran M

doi

10.1016/j.transproceed.2013.02.068

subject

Has Abstract

pub_date

2013-04-01 00:00:00

pages

1009-12

issue

3

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(13)00257-1

journal_volume

45

pub_type

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