PedsCrit
Norwood Part 3: Anticoagulation, Extubation, & Interstage Considerations with Dr. Greg Yurasek
Jun 12, 2023
Dr. Greg Yurasek discusses anticoagulation, extubation, and interstage considerations after a Norwood procedure. Topics include EEG use in Norwood patients, managing acute hypoxemia with a BTT shunt, complications in intubated children post-surgery, extubation in pediatric patients with heart disease, and establishing relationships in the Cardiac ICU.
27:52
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Quick takeaways
- Assessing ventricular function and addressing issues promptly is crucial in managing low cardiac output in Norwood patients, including valve regurgitation or fluid buildup, and considering mechanical support or optimization strategies if needed.
- Optimal extubation in Norwood patients involves various considerations such as transitioning off sedation, evaluating ventilation and diaphragm function, assessing systemic and pulmonary blood flow ratios, and resolving complications like arrhythmias or vocal cord paralysis.
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Key points on post-operative Norwood care
The final part of the podcast series focuses on post-operative care for Norwood patients. The key areas of concern are anticoagulation, extubation, transfer, and preparing the patient for the Glenn procedure. When faced with signs of low cardiac output, it is crucial to assess ventricular function with an echo and address any issues such as valve regurgitation or fluid buildup. The severity and timing of the symptoms determine whether mechanical support or optimization strategies, like volume replenishment, are required. EEG monitoring is also recommended to detect seizures. Additionally, the podcast discusses the prevention of shunt occlusions through the use of heparin and anti-platelet agents.
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