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PedsCrit
Norwood Part 1: Pre-Operative Physiology & Management with Dr. Greg Yurasek
May 29, 2023
Dr. Greg Yurasek, a pediatric cardiology fellowship graduate, discusses topics such as single ventricle physiology, timing of procedures, assessing blood flow in pediatric patients, and pre-operative feeding challenges for single-ventricle patients.
31:57
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Quick takeaways
- Administering prostaglandin before the Norwood procedure in single ventricle patients is crucial to maintain systemic oxygen delivery by keeping the ductus arteriosus open.
- When evaluating preoperative single ventricle patients, clinicians should assess the patient's overall appearance, pulses, capillary refill, and respiratory status to determine if adequate systemic and pulmonary blood flow is achieved.
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Preoperative considerations for single ventricle patients
Prior to the Norwood procedure, single ventricle patients, such as those with hypoplastic left heart syndrome, require specific preoperative care. One essential step is to administer prostaglandin to keep the ductus arteriosus open, allowing for sufficient systemic oxygen delivery. Diagnostic workup, including brain imaging and genetic assessments, is performed while waiting for the pulmonary vascular resistance to decrease. Close monitoring of the patient's overall appearance, including capillary refill, feeding tolerance, and respiratory status, is crucial. Oral feeding is often initiated, although tube feeding is generally avoided. Diuretics may be used to manage pulmonary edema and optimize respiratory function. The goal is to ensure the stable transition of the patient and establish a baseline before proceeding with the Norwood procedure.
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