Aw Tuan Chen, Chan Belinda, Singh Yogen
Department of Anaesthesia, Royal Brompton Hospital, London SW3 6NP, UK.
Neonatology Division, Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA.
J Cardiovasc Dev Dis. 2023 Sep 1;10(9):377. doi: 10.3390/jcdd10090377.
Transcatheter device closure of patent ductus arteriosus (PDA) in preterm infants has been proven to be a feasible and safe technique with promising results when compared to surgical ligation. However, managing transport and anaesthesia in extremely premature infants with haemodynamically significant PDA and limited reserves presents unique challenges. This review article focuses on the key considerations throughout the clinical pathway for the PDA device closure, including referral hospital consultation, patient selection, intra- and inter-hospital transport, and anaesthesia management. The key elements encompass comprehensive patient assessment, meticulous airway management, optimised ventilation strategies, precise thermoregulation, patient-tailored sedation protocols, vigilant haemodynamic monitoring, and safe transport measures throughout the pre-operative, intra-operative, and post-operative phases. A multidisciplinary approach enhances the chances of procedure success, improves patient outcomes, and minimises the risk of complications.
与手术结扎相比,经导管装置闭合早产儿动脉导管未闭(PDA)已被证明是一种可行且安全的技术,效果良好。然而,对于患有血流动力学显著的PDA且储备有限的极早产儿,管理转运和麻醉存在独特挑战。这篇综述文章重点关注PDA装置闭合临床路径中的关键考量因素,包括转诊医院会诊、患者选择、院内和院际转运以及麻醉管理。关键要素包括全面的患者评估、细致的气道管理、优化的通气策略、精确的体温调节、个性化的镇静方案、严密的血流动力学监测以及术前、术中和术后阶段的安全转运措施。多学科方法可提高手术成功率,改善患者预后,并将并发症风险降至最低。