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OPENPediatrics

Anesthesia for Non-Cardiac Surgeries: Unrepaired TOF | OPENPediatrics

Sep 4, 2024
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.
25:37

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Quick takeaways

  • 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.

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