Anesthesia in pediatric heart transplantation.

Heart transplantation is a widely accepted therapy for end-stage myocardial failure in adults. However, few centers have experience in the treatment of newborns and children. The management of these children from the anesthesiologic viewpoint is demonstrated in our first 10 patients. Ages ranged from 5 days to 5 years; weights ranged from 2900 gm to 16 kg. The children suffered from hypoplastic left heart syndrome (n = 5) or cardiomyopathy (n = 5). Eight patients had to receive catecholamines (dobutamine) before surgery. In neonates cardiopulmonary bypass (CPB) with hypothermic cardiac arrest at 18 degrees C was used; in the older children continuous CPB at 24 degrees to 28 degrees C was performed. Inotropic support during and after weaning from CPB was necessary in all patients who received dobutamine (range, 2 to 10 micrograms/kg/min), epinephrine (range, 0.03 to 1.0 microgram/kg/min), or both. The phosphodiesterase inhibitor enoximone (1.0 mg/kg) was administered to five patients. Prostaglandin E1 was given to four patients, and it was necessary to give additional tolazoline to two patients. Heart transplantation is a challenge for anesthesiologists during the prebypass period as well as during the weaning and early postbypass periods. More experience is necessary to optimize the anesthetic management of these children.