Pratap Jayant N, Wilmshurst Sally
Department of Anaesthesia, Great Ormond Street Hospital, London, UK.
Paediatr Anaesth. 2010 Sep;20(9):812-20. doi: 10.1111/j.1460-9592.2010.03352.x.
Modern mechanical devices can support children with severely impaired cardiac function until a donor heart is found for transplantation or native function recovers. Pediatric heart transplantation offers a good chance of survival with a high quality of life to individuals with limited life expectancy and/or severe limitation to daily activities, but many die on the transplant list or are not listed because of a shortage of donor organs. In recent cohorts, there is better outcome when ventricular assist devices (VADs) rather than extracorporeal membrane oxygenation are used as a 'bridge' to transplantation. Anesthesiologists working in centers where VADs are available may increasingly be asked to provide anesthesia to children with such devices in situ, including procedures outside the cardiac surgical operating room. The Berlin Heart EXCOR device is a VAD system with increasing popularity in pediatric practice and has system components available in sizes suitable even for neonates. Postimplantation considerations include hemodynamics, thromboembolic complications and their prevention by anticoagulation, antimicrobial therapy, and the rehabilitation and mobilization of recipients. VAD-specific emergencies must be recognized and managed appropriately by anesthesiologists looking after Berlin Heart recipients. These include malignant dysrhythmias, sudden loss of VAD output, air or clot embolism, and sudden cyanosis. Provision of anesthesia for patients with an in situ Berlin Heart requires attention to particular considerations in preoperative assessment, induction, maintenance, and postoperative care.
现代机械设备可以支持心功能严重受损的儿童，直至找到供体心脏进行移植或自身功能恢复。小儿心脏移植为预期寿命有限和/或日常活动严重受限的个体提供了良好的生存机会和较高的生活质量，但由于供体器官短缺，许多人在移植名单上死亡或未被列入名单。在最近的队列研究中，使用心室辅助装置（VAD）而非体外膜肺氧合作为移植“桥梁”时，结果更好。在有VAD的中心工作的麻醉医生可能会越来越多地被要求为携带此类装置的儿童就地提供麻醉，包括在心脏外科手术室以外的手术。柏林心脏EXCOR装置是一种在儿科实践中越来越受欢迎的VAD系统，其系统组件的尺寸甚至适合新生儿。植入后的考虑因素包括血流动力学、血栓栓塞并发症及其通过抗凝、抗菌治疗以及受体的康复和活动来预防。照顾柏林心脏受体的麻醉医生必须认识并妥善处理VAD特有的紧急情况。这些情况包括恶性心律失常、VAD输出突然丧失、空气或血栓栓塞以及突然发绀。为就地使用柏林心脏的患者提供麻醉需要在术前评估、诱导、维持和术后护理中注意特殊考虑因素。
