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Perioperative respiratory compliance in children undergoing repair of atrial septal defects
D L Shulman1, F A Burrows, D J Poppe
1Department of Anaesthesia, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Children with atrial septal defects (ASD) show reduced respiratory compliance (Crs) during sedation but not during anesthesia. This finding is crucial for anesthetic management in pediatric patients undergoing ASD correction.
Area of Science:
- Pediatric Anesthesiology
- Cardiology
- Respiratory Physiology
Background:
- Children with atrial septal defects (ASD) often exhibit reduced respiratory compliance (Crs) compared to healthy children.
- This decreased compliance may pose challenges for anesthetic management during surgical correction.
Purpose of the Study:
- To investigate changes in Crs in pediatric patients before, during, and after surgical correction of ASD.
- To compare Crs in ASD patients with a control group undergoing non-thoracic surgery.
- To explore the relationship between Crs and the pulmonary to systemic flow ratio (Qp:Qs) in ASD patients.
Main Methods:
- Crs was measured in 29 infants and children (15 with ASD, 14 controls) using single breath technique (sedation) and inflation technique (anesthesia).
- Echocardiography was used to determine the Qp:Qs ratio in ASD patients during sedation.
- Crs was assessed during sedation, and during anesthesia before and after surgery.
Main Results:
- During sedation, ASD patients had significantly lower Crs (52.7% less) than controls.
- The regression of Crs vs. height was significantly less steep in the ASD group during sedation.
- However, no significant difference in Crs was observed between ASD and control groups during anesthesia, before or after surgery.
Conclusions:
- Despite lower Crs during sedation, infants and children with ASD do not exhibit reduced Crs during anesthesia and cardiopulmonary bypass.
- Anesthetic management for pediatric ASD correction may not require special adjustments for respiratory compliance.
- The observed decrease in Crs during sedation in ASD patients did not correlate with the Qp:Qs ratio.
Abstract:
Children with atrial septal defects (ASD) have less respiratory compliance (Crs) than normal cohorts. There could be implications for anaesthetic management if these children also have decreased compliance during anaesthesia. To examine the changes in Crs before, during and following surgical correction of the atrial defect, Crs was measured in 29 infants and children, 15 undergoing correction of secundum type atrial septal defects, and a group of 14 children of similar weight undergoing non-thoracic surgery. During sedation, Crs was measured using the single breath technique (SBT) and during anaesthesia, both before and after the surgical procedure, an inflation technique was applied to determine Crs. To investigate the aetiology of the difference in Crs, the pulmonary to systemic flow ratio (Qp:Qs) was determined using echocardiography during sedation in the ASD patients. During sedation, Crs in the ASD group was 52.7 +/- 19.5% less than in the control group. The slope of the line of regression of Crs vs height for the ASD group was significantly less (P less than 0.05) than that of the control group during sedation. However, during anaesthesia, Crs in the ASD group was not significantly different from the control group either before or after surgery. The per cent decrease in Crs during sedation in the children with ASD, in comparison with the control group, did not correlate with the Qp:Qs ratio of the ASD group (r2 = 0.012,NS). We conclude that, in spite of lower Crs during sedation, infants and children with ASD do not have lower Crs during anaesthesia and cardiopulmonary bypass than normal controls undergoing non-thoracic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)