Raha Abhijeet, Ganjoo Pragati, Singh Amay, Tandon Monica S, Singh Daljit
Department of Anaesthesiology and Intensive Care, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India.
J Pediatr Neurosci. 2012 Jan;7(1):23-6. doi: 10.4103/1817-1745.97617.
Patients with cyanotic congenital heart disease (cCHD) are prone to develop frequent brain abscesses. Surgery for these abscesses is often limited to aspiration under local anesthesia because excision under general anesthesia (GA) is considered a riskier option. Perioperative hemodynamic instability, cyanotic spells, coagulation defects, electrolyte and acid base imbalance, and sudden cardiac arrest are among the major anesthetic concerns. Most of our current knowledge in this area has been gained from a neurosurgical standpoint while there is a paucity of corresponding anesthesia literature.
To highlight the anesthesia issues involved in cCHD children undergoing brain abscess excision under GA.
Retrospective study of our institutional experience over a 5 year period.
Of all the children with cCHD who underwent brain abscess surgery from January 2005 to December 2009, only 4 were operated under GA. Surgery was done after correcting fever, dehydration, electrolyte imbalance, coagulopathy and acid-base abnormalities, and taking appropriate intraoperative steps to maintain hemodynamic stability and prevent cyanotic spells and arrhythmias.
All 4 patients had a successful abscess excision though with varying degrees of intraoperative problems. There was one death, on postoperative day 34, due to septicemia.
Brain abscess excision under GA in children of cCHD can be safely carried out with proper planning and attention to detail.
患有青紫型先天性心脏病（cCHD）的患者容易频繁发生脑脓肿。这些脓肿的手术通常仅限于局部麻醉下的抽吸，因为全身麻醉（GA）下的切除被认为是风险更高的选择。围手术期血流动力学不稳定、青紫发作、凝血缺陷、电解质和酸碱失衡以及心搏骤停是主要的麻醉关注点。我们目前在这一领域的大部分知识都是从神经外科的角度获得的，而相应的麻醉文献却很少。
强调在全身麻醉下接受脑脓肿切除的cCHD儿童所涉及的麻醉问题。
对我们机构5年期间的经验进行回顾性研究。
在2005年1月至2009年12月期间接受脑脓肿手术的所有cCHD儿童中，只有4例在全身麻醉下进行了手术。在纠正发热、脱水、电解质失衡、凝血障碍和酸碱异常后进行手术，并采取适当的术中措施维持血流动力学稳定，预防青紫发作和心律失常。
所有4例患者均成功切除脓肿，尽管术中出现了不同程度的问题。有1例患者在术后第34天因败血症死亡。
通过适当的规划和对细节的关注，cCHD儿童在全身麻醉下进行脑脓肿切除可以安全实施。
