Anesthesia for Non-Cardiac Surgeries: Unrepaired TOF | OPENPediatrics
Sep 4, 2024
auto_awesome
Join Annette Schure, a Senior Associate in Cardiac Anesthesia at Boston Children's Hospital and Assistant Professor at Harvard Medical School, as she delves into the complexities of anesthesia for patients with unrepaired tetralogy of Fallot. She discusses essential preoperative evaluations and strategies to ensure safety during non-cardiac surgeries. The conversation also highlights the unique challenges of laparoscopic procedures, emphasizing the importance of careful postoperative care and multimodal analgesia to minimize risks.
A thorough preoperative evaluation for patients with unrepaired tetralogy of Fallot is essential, focusing on history, comorbidities, and echocardiographic assessments.
Intraoperative anesthetic management must prioritize hemodynamic stability and minimize TET spells through careful drug selection and close surgical team collaboration.
Deep dives
Preoperative Evaluation for Tetralogy of Fallot
Preoperative evaluation is crucial for patients with unrepaired tetralogy of Fallot, beginning with a detailed history and physical examination. A thorough review of the patient’s past should include coexisting syndromes such as CHARGE or 22Q11.2 deletions, which can complicate anesthetic management due to associated airway abnormalities or metabolic issues. Additionally, the evaluation must assess the frequency and triggers of recurrent cyanosis episodes, particularly given that conditions like DeGeorge syndrome, common in these patients, can lead to significant immunodeficiency. Echocardiography plays a vital role in providing comprehensive information about the cardiac defect and the patient's clinical status, including their typical behavior and symptoms during stress.
Anesthetic Management Considerations
Anesthetic management in patients with unrepaired tetralogy of Fallot requires careful monitoring due to the risk of TET spells, which can occur during surgical procedures. The anesthetic approach may involve a combination of midazolam and ketamine to prevent agitation and exacerbate hypercyanotic spells. It is important to maintain hemodynamics and minimize any potential hypotension during induction, as these patients can be sensitive to positive pressure ventilation and intravenous anesthetics that may decrease systemic vascular resistance. Close collaboration with the surgical team is essential to optimize anesthesia levels and prevent acidosis or hypoxia that could trigger adverse events.
Postoperative and Surgical Considerations
Postoperative care for neonates with unrepaired tetralogy of Fallot involves skilled monitoring in an intensive care setting to manage potential complications such as TET spells. Effective pain control is achieved through a multimodal approach, incorporating medications like acetaminophen, morphine, and regional anesthesia to ensure comfort during recovery. Surgical procedures for these patients are typically limited to urgent situations, such as addressing congenital anomalies, given the high risk of complications. Postoperative management must include vigilance for signs of hemodynamic instability and optimizing fluid management to maintain adequate preload, vital for preventing significant desaturation.
1.
Anesthesia Considerations for Non-Cardiac Surgeries in Unrepaired Tetralogy of Fallot
This podcast discusses anesthetic considerations for patients with unrepaired tetralogy of Fallot who are undergoing non-cardiac surgeries.
LEARNING OBJECTIVES
Upon listening to this podcast, learners will be able to:
- Explain preoperative considerations
- Provide an anesthetic management plan
- Describe specific non-cardiac surgical procedures and the considerations that need to be addressed when performing them
- Anticipate the postoperative considerations
AUTHORS
Annette Schure, MD
Senior Associate in Cardiac Anesthesia
Boston Children's Hospital
Assistant Professor of Anesthesia
Harvard Medical School
Christian Refakis, MD
Clinical Fellow
Department of Anesthesiology, Critical Care and Pain Medicine,
Boston Children's Hospital
Robert Soohey
Medical Student
Tufts University School Of Medicine
DATES
Initial publication: September 4, 2024.
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu
CITATION
Refakis C, Marcley S, Soohey R, Marques B, Wolbrink TA, Schure AY. Anesthesia for Non-Cardiac Surgeries: Unrepaired TOF. 09/2024. OPENPediatrics. Podcast: https://soundcloud.com/openpediatrics/anesthesia-for-non-cardiac-surgeries-unrepaired-tof-openpediatrics.
Get the Snipd podcast app
Unlock the knowledge in podcasts with the podcast player of the future.
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode
Save any moment
Hear something you like? Tap your headphones to save it with AI-generated key takeaways
Share & Export
Send highlights to Twitter, WhatsApp or export them to Notion, Readwise & more
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode