Cave Dominic A, Fry Kathryn M, Buchholz Holger
Department of Anesthesiology and Pain Medicine, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada.
Paediatr Anaesth. 2010 Jul;20(7):647-59. doi: 10.1111/j.1460-9592.2010.03314.x. Epub 2010 Apr 23.
To report our experience of providing anesthesia for noncardiac procedures in children with in situ Berlin Heart EXCOR Pediatric ventricular assist devices and to suggest principles of anesthetic management.
With the initiation of the first North American training and support center for Berlin Heart at our institution in 2006, we have been asked to provide anesthesia for noncardiac procedures to these children. No current anesthetic approach to these children has been reported.
METHODS/MATERIALS: Anesthetic records for all noncardiac procedures for children with Berlin Heart between August 2006 and February 2009 in a tertiary care pediatric hospital were retrospectively reviewed. Charts were reviewed for demographic and clinical data, perioperative management, and occurrence of hypotension.
Twenty-nine procedures were performed on 11 patients. Hypotension was a common occurrence with all anesthetic induction and maintenance agents even at low doses. Ketamine induction, however, was less likely to produce hypotension, odds ratio for hypotension 0.1333 (95% confidence range 0.021-0.856). Hypotension was responsive to fluid bolus (60%) and alpha-receptor agonists (100%). Preoperative stability and presence of biventricular ventricular assist device (BiVAD) did not predict intraoperative hemodynamic course.
Unlike patients with other ventricular assist devices, these children do not tolerate reductions in systemic vascular resistance (SVR) because of the relatively fixed cardiac output of this device. Agents that reduce SVR should be avoided where possible. Preoperative stability is not predictive. Fluids and alpha-agonists should be first-line response to hypotension in this population. Further study of this unusual population is warranted to further delineate best anesthetic practice.
报告我们为植入原位柏林心脏EXCOR小儿心室辅助装置的儿童进行非心脏手术麻醉的经验，并提出麻醉管理原则。
随着2006年我们机构启动北美首个柏林心脏培训与支持中心，我们被要求为这些儿童的非心脏手术提供麻醉。目前尚未有针对这些儿童的麻醉方法的报道。
方法/材料：回顾性分析了2006年8月至2009年2月在一家三级儿科医院为植入柏林心脏的儿童进行的所有非心脏手术的麻醉记录。查阅病历以获取人口统计学和临床数据、围手术期管理以及低血压的发生情况。
对11名患者进行了29例手术。即使使用低剂量的所有麻醉诱导和维持药物，低血压也很常见。然而，氯胺酮诱导产生低血压的可能性较小，低血压的优势比为0.1333（95%置信区间0.021 - 0.856）。低血压对快速补液（60%）和α受体激动剂（100%）有反应。术前稳定性和双心室心室辅助装置（BiVAD）的存在并不能预测术中血流动力学过程。
与其他心室辅助装置的患者不同，由于该装置的心输出量相对固定这些儿童不能耐受体循环血管阻力（SVR）的降低。应尽可能避免使用降低SVR的药物。术前稳定性并无预测作用。对于该人群，液体和α激动剂应作为低血压的一线应对措施。有必要对这一特殊人群进行进一步研究，以进一步明确最佳麻醉实践。
