Anaesthetic experience with paediatric interventional cardiology

Area of Science:

• Pediatric Cardiology
• Anesthesiology
• Interventional Cardiology

Background:

• Interventional cardiologic procedures in children require careful anesthetic and sedation management.
• Various techniques, including sedation, ketamine, inhalational, and narcotic anesthesia, are employed.

Purpose of the Study:

• To review anesthetic and sedation techniques, their complications, and outcomes in pediatric interventional cardiology.
• To compare the safety and efficacy of different anesthetic methods.

Main Methods:

• Retrospective review of 176 children undergoing 184 interventional cardiologic procedures.
• Analysis of anesthetic techniques used: sedation only, ketamine infusion, inhalational anesthesia, and narcotic anesthesia.
• Assessment of complications such as respiratory issues, airway obstruction, and vascular compromise.

Main Results:

• Ketamine infusion was the most frequent technique but was associated with a higher incidence of respiratory complications (P < 0.05).
• Hypercarbia (15.6%) and upper airway obstruction (7.8%) were observed, with ketamine potentially linked to hypercarbia due to supplemental sedatives.
• Vascular compromise occurred in 33 patients, requiring surgery in 16; cardiac perforation occurred in 4, leading to one death.

Conclusions:

• Ketamine is preferred by cardiologists for general anesthesia in cardiac catheterization but requires vigilant monitoring.
• Avoiding concomitant narcotics with ketamine, when spontaneous ventilation is used, is recommended to minimize respiratory complications.
• Pulmonary valve stenosis responded best to balloon dilatation, while aortic valve stenosis was least amenable.