Department of Anesthesiology, University of Texas Health Science Center at Houston, Houston, Texas.
Paediatr Anaesth. 2020 Apr;30(4):506-510. doi: 10.1111/pan.13838. Epub 2020 Feb 24.
The patent ductus arteriosus is a cardiac lesion commonly found in premature neonates. Though surgical closure via thoracotomy is the most definitive treatment option, it is associated with significant morbidity. New catheter-based closure options offer a potentially safer alternative treatment, even in premature neonates. However, no literature reports the anesthetic techniques, challenges, and risks associated with this procedure in this population.
This study documents the anesthetic challenges and potential complications associated with the management of catheter-based closure of the ductus arteriosus in neonates under 3 kg.
This single-center, retrospective study examined patients who underwent catheter-based ductus arteriosus closure between August 2015 and February 2019. A clinical protocol for anesthetic management of these patients was utilized throughout the study period. Clinical outcomes considered were new hemodynamic instability or vasoactive medication requirements, hypothermia, prolonged intubation (>3 days postoperatively), postprocedure acute kidney injury, perioperative red blood cell transfusion, and accidental extubation.
Seventy-six neonates underwent 78 procedures. No patient developed perioperative hemodynamic instability, vasoactive medication requirements, or acute kidney injury. Four patients (5%) required red blood cell transfusion, two (3%) became hypothermic, and one (1%) was accidentally extubated. Closure was achieved in 73 patients (96%) on the first attempt. However, 17 patients (40%) required prolonged periods of mechanical ventilation following the procedure.
Despite multiple clinical and logistical challenges, anesthetic risk associated with catheter-based PDA closure in small neonates can be effectively managed through standardized and multidisciplinary care.
动脉导管未闭是一种常见于早产儿的心脏病变。虽然经胸开胸手术闭合是最有效的治疗选择，但它与显著的发病率相关。新的导管介入闭合选择提供了一种潜在更安全的替代治疗方法，甚至在早产儿中也是如此。然而，没有文献报道在该人群中与该程序相关的麻醉技术、挑战和风险。
本研究记录了在 3 公斤以下新生儿中经导管动脉导管未闭闭合术的麻醉挑战和潜在并发症。
这项单中心回顾性研究检查了 2015 年 8 月至 2019 年 2 月期间接受经导管动脉导管未闭闭合术的患者。整个研究期间都使用了针对这些患者的麻醉管理临床方案。考虑的临床结果是新的血流动力学不稳定或血管活性药物需求、低体温、长时间插管（术后>3 天）、术后急性肾损伤、围手术期红细胞输血和意外拔管。
76 名新生儿进行了 78 次手术。没有患者出现围手术期血流动力学不稳定、血管活性药物需求或急性肾损伤。4 名患者（5%）需要输血，2 名（3%）体温过低，1 名（1%）意外拔管。73 名患者（96%）在第一次尝试时成功闭合。然而，17 名患者（40%）在手术后需要长时间机械通气。
尽管存在多种临床和后勤挑战，但通过标准化和多学科护理，可以有效地管理小早产儿经导管 PDA 闭合术的麻醉风险。
