Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany.
Emergency Department, Rheinische Friedrich-Wilhelms-University, University Medical Center, Bonn, Germany.
World J Pediatr Congenit Heart Surg. 2020 May;11(3):257-264. doi: 10.1177/2150135120902122.
Providing anesthesia for pediatric patients undergoing congenital cardiac surgery is complex and requires profound knowledge and clinical experience. Prospective studies on best anesthetic management are missing, partially due to different standards. The aim of the present study was to survey the current standard practice in anesthetic management in pediatric cardiac surgical centers in Germany.
All 78 cardiac surgical centers in Germany were reviewed for a congenital cardiac surgery program. Centers with an active program for congenital cardiac surgery were interviewed to participate in the present online questionnaire to assess their current anesthetic practice.
Twenty-seven German centers running an active program for congenital heart surgery were identified, covering more than 3,000 pediatric cardiac surgeries annually. Of these centers, 96.3% (26/27) participated in our survey. Standard induction agents were etomidate in 26.9% (7/26), propofol in 19.2% (5/26), a combination of benzodiazepines and ketamine in 19.2% (5/26), and barbiturates in 11.5% (3/26). General anesthesia was preferentially maintained using volatile agents, 61.5% (16/26), with sevoflurane being the most common volatile agent within this group, 81.2% (13/16). Intraoperative first-choice/first-line inotropic drug was epinephrine, 53.8% (14/26), followed by milrinone, 23.1% (6/26), and dobutamine 15.4% (4/26). Fast-track programs performing on-table extubation depending on the type of surgical procedure were established at 61.5% (16/26) of the centers.
This study highlights the diversity of clinical standards in pediatric cardiac anesthesia for congenital cardiac surgery in Germany.
为接受先天性心脏手术的儿科患者提供麻醉较为复杂，需要深厚的知识和临床经验。由于标准不同，部分原因是缺乏关于最佳麻醉管理的前瞻性研究。本研究旨在调查德国儿科心脏外科中心麻醉管理的当前标准做法。
对德国所有 78 家心脏外科中心进行了先天性心脏手术项目审查。对有先天性心脏手术活跃项目的中心进行了访谈，邀请他们参与本在线问卷调查，以评估其当前的麻醉实践。
确定了 27 个开展先天性心脏手术活跃项目的德国中心，每年进行超过 3000 例儿科心脏手术。其中 96.3%（26/27）的中心参与了我们的调查。标准诱导药物为依托咪酯 26.9%（26/7）、异丙酚 19.2%（5/26）、苯二氮䓬类和氯胺酮的组合 19.2%（5/26）、巴比妥类 11.5%（3/26）。61.5%（16/26）的中心优先使用挥发性药物维持全身麻醉，其中最常用的挥发性药物为七氟醚 81.2%（13/16）。术中首选/一线正性肌力药物为肾上腺素 53.8%（14/26），其次为米力农 23.1%（6/26）和多巴酚丁胺 15.4%（4/26）。61.5%（16/26）的中心根据手术类型建立了在台上拔管的快速通道方案。
本研究强调了德国先天性心脏手术儿科心脏麻醉临床标准的多样性。
