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Paediatric cardiomyopathy and anaesthesia
R J Ing1, W A Ames, N A Chambers
1Department of Anesthesiology, Children's Hospital Colorado, Anschutz Medical Campus, 13123 East 16th Ave., Aurora, CO 80045, USA.
Insights
Pediatric cardiomyopathy (CM) poses significant anesthesia risks. This review details CM types, focusing on anesthetic management strategies for children with dilated, hypertrophic, and restrictive forms.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Cardiovascular Medicine
Background:
- Cardiomyopathy (CM) is a myocardial disease causing cardiac dysfunction, posing risks in pediatric anesthesia.
- Undiagnosed CM can lead to cardiac arrest during anesthesia in children.
- Managing pediatric CM requires tailored anesthetic goals to maintain hemodynamic stability.
Purpose of the Study:
- To review the pathology, etiology, and clinical presentation of different pediatric cardiomyopathy forms.
- To examine recent therapeutic advances, including end-stage disease management.
- To highlight specific anesthetic considerations for children with various CM types.
Main Methods:
- Review of current literature on pediatric cardiomyopathy.
- Analysis of diagnostic tools and cardiac imaging advancements.
- Examination of evolving treatment modalities, including ventricular assist devices.
Main Results:
- Dilated, hypertrophic, and restrictive cardiomyopathies are the most common forms in children.
- Anesthetic management must address specific hemodynamic needs for each CM type.
- Advances in diagnostics and therapeutics are refining anesthetic care.
Conclusions:
- Understanding specific CM types is crucial for safe pediatric anesthesia.
- Tailored anesthetic strategies are essential for optimizing outcomes in children with CM.
- Ongoing advancements necessitate continuous updates in anesthetic management protocols.
Abstract:
'Cardiomyopathy' (CM) is defined by the World Health Organization as 'a disease of the myocardium associated with cardiac dysfunction'. In a child, it is associated with a significant risk for anaesthesia. In addition, cardiac arrest under anaesthesia has been attributed to an undiagnosed CM. Care of these patients is complicated by the fact that there are several different forms of CM that have differing anaesthesia management goals, aimed at maintaining the patient's baseline haemodynamic variables of preload, heart rate, contractility, and afterload. With the emergence of new diagnostic tools, together with advances in cardiac imaging and improved treatment modalities (such as ventricular assist devices), the anaesthetic management of a child with a CM is evolving. This review describes the different forms of the disease in terms of pathology, aetiology, and clinical presentation. Dilated, hypertrophic, and restrictive CM are the most common forms. We examine recent advances in therapy, including the management of severe end-stage disease, while highlighting the specific anaesthetic considerations for children with each type of CM.
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