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Peripheral Nerve Injuries in Patients Undergoing Congenital Cardiac Surgery and Cardiac Catheterization
Julian Hubrich1, Woong Y Hwang2, Viviane G Nasr3
1Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anesthesiology, Mass General Brigham, Brigham and Women's Hospital, Boston, MA; German Heart Center Munich/Paul Philipp Heinisch, Munich, Germany.
Objectives:
Peripheral nerve injury (PNI) is a clinically significant but frequently under-recognized complication after cardiac surgery and catheterization, contributing to postoperative morbidity. While PNI has been well characterized in adult cardiac populations, evidence in children and adolescents remains limited. This study aimed to describe and review patients with documented PNI following congenital cardiac interventions, focusing on identifying potential risk factors, assessing differences between surgery and catheterization, and evaluating clinical outcomes.
Design:
Retrospective study.
Setting:
Observational study at a single tertiary academic center.
Participants:
Children, adolescents, and young adults with documented PNI following cardiac surgery or catheterization.
Interventions:
No intervention.
Measurements And Main Results:
Thirty patients with PNI were identified, 19 (63.3%) after cardiac surgery and 11 (36.7%) after cardiac catheterization. More severe cases of PNI were observed after surgery, with PNI remaining unresolved in 8 surgical patients (42.1%), while all injuries resolved in catheterization patients. The surgical cohort exhibited a longer procedure duration of 487.0 minutes (interquartile range, 456.0-581.5 minutes) and a lower temperature of 32.4°C (interquartile range, 31.3°C-33.8°C). In 53.3% of all cases, a peripheral intravenous catheter or blood pressure cuff was placed on the same side as the affected limb. The majority of surgical patients (n = 15, 78.9%) experienced PNI in the lower extremities; conversely, the upper extremities were more commonly affected during catheterization (n = 10, 90.9%).
Conclusions:
PNI is a significant complication in children, adolescents, and young adults following cardiac procedures, with more severe cases occurring after surgery. This complication warrants more attention in pediatric patients.
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