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Risk Recognition and Multidisciplinary Approach for Non-Cardiac Surgeries in Paediatric Cardiac Patients: A
Poonam Motiani1, Vibha Chhabra1, Zainab Ahmad2
1Paediatric Anaesthesia, Super Speciality Paediatric Hospital & Post Graduate Teaching Institute, Noida, IND.
Insights
Pediatric anesthesia for non-cardiac surgery in children with congenital heart disease (CHD) is safe. Careful preoperative optimization and multidisciplinary care ensure uneventful outcomes for these high-risk patients.
Area of Science:
- Pediatric Anesthesiology
- Cardiology
- Congenital Heart Disease
Background:
- Congenital heart disease (CHD) is the most common birth defect, affecting 1 in 125 live births globally.
- Patients with CHD may require surgery for associated extra-cardiac anomalies, necessitating specialized anesthetic management.
- Understanding the pathophysiology of cardiac lesions and associated risks is crucial for safe anesthesia in pediatric patients.
Purpose of the Study:
- To review anesthetic management and outcomes of pediatric patients with significant cardiac lesions undergoing non-cardiac surgery.
- To highlight the approach to peri-operative care for this high-risk population.
Main Methods:
- Retrospective chart review of pediatric patients (0-18 years) with CHD undergoing non-cardiac surgery between January 1, 2018, and December 31, 2019.
- Inclusion criteria: diagnosed CHD (repaired or unrepaired) undergoing anesthesia or Monitored Anesthesia Care (MAC).
- Exclusion criteria: procedures under local anesthesia or sedation without an anesthesiologist.
Main Results:
- Five eligible cases underwent six non-cardiac procedures (five elective, one emergency).
- Preoperative optimization involved a multidisciplinary team, including surgeons, anesthesiologists, and cardiologists.
- All six anesthetic encounters were safe and uneventful, with no adverse events or complications.
Conclusions:
- Anesthetic management for non-cardiac surgery in children with CHD can be safely achieved with careful planning and a multidisciplinary approach.
- Pediatric patients with CHD tolerated anesthesia well for non-cardiac procedures in this study.
- This highlights the feasibility and safety of elective non-cardiac surgeries in children with congenital heart defects.
Abstract:
Background Congenital heart disease (CHD), a structural and functional heart disease, is the commonest birth defect with an incidence of one in 125 live births worldwide with ventricular septal defect (VSD), atrial septal defect (ASD) and tetralogy of Fallot (TOF) constituting the majority. Surgery for associated extra-cardiac anomalies (airway, skeletal, genitourinary, and gastrointestinal) may be required in 30% of these patients. Delivery of uneventful anaesthesia in these children requires an understanding of not only paediatric anaesthesia but also of the pathophysiology of the cardiac lesion and its associated risks. Aims The purpose of this retrospective review was to highlight the approach to the anaesthetic management and outcomes of patients with significant cardiac lesions presenting for non-cardiac surgeries. Material and methods A retrospective chart review of all children with congenital heart disease (CHD) (repaired or unrepaired) who were posted for a non-cardiac surgery in this tertiary care Paediatric super-specialty hospital from January 1, 2018 to December 31, 2019 was carried out. Data on demographics, peri-operative management, and clinical course was retrieved. Inclusion criteria were paediatric patients (0-18 years) of either gender with a diagnosis of a CHD (repaired or unrepaired) undergoing any non-cardiac surgeries (NCS) under anaesthesia/Monitored Anaesthesia Care (MAC). Exclusion criteria were procedures only under local anaesthesia (LA) or a minor procedure done solely under sedation not involving an anaesthesiologist. Results During the study period, we found five eligible cases who underwent a total of six procedures. Five procedures were elective and one was an emergency. Preoperative optimization was conducted by a multidisciplinary team including paediatric surgeons, anaesthesiologists, physicians, and cardio-thoracic surgeons. Anaesthesia was conducted by at least a consultant paediatric anaesthesiologist. Overall all patients tolerated anaesthesia well without any adverse events or complications. All six anaesthetic encounters were safe and uneventful.
