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Published on: August 4, 2021
Anesthetic Implications and Physiologic Response to Transcatheter Pulmonary Flow Restrictor Placement in Neonates: A
Patrick Hussey1, Evan Liu1, Kevin Wall2
1Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham.
Objective:
To characterize intraprocedural anesthetic management and physiologic responses during sequential transcatheter pulmonary flow restrictor (PFR) implantation in neonates and infants with complex congenital heart disease.
Design:
Single-center retrospective cohort study.
Setting:
Tertiary congenital cardiac catheterization laboratory at an academic children's hospital.
Participants:
Twenty-two neonates and infants undergoing sequential bilateral PFR implantation.
Interventions:
Transcatheter deployment of modified microvascular plug pulmonary flow restrictors under general anesthesia with either volatile or intravenous anesthetic techniques.
Measurements And Main Results:
Ventilatory (oxygen saturation [SpO2], FiO2, EtCO2, peak inspiratory pressure, tidal volume) and hemodynamic variables (mean arterial pressure, systolic blood pressure, diastolic blood pressure, heart rate) were collected at 3 standardized timepoints: predeployment, after PFR 1 deployment, and after PFR 2 deployment. Statistical analysis used the Friedman test and post-hoc pairwise Wilcoxon signed-rank comparison with Benjamini-Hochberg FDR adjustment. PFR placement reduced SpO₂ from 93% to 88% (Friedman Q = 7.878, p = 0.019) while producing significant stepwise increases in systemic pressures (mean arterial pressure increased from 42.5 to 54.5 mmHg, Friedman Q = 21.04, p = 2.7 × 10⁻⁵) and reductions in heart rate (152 to 144 bpm, Friedman Q = 9.33, p = 0.0094). Volatile anesthesia was initially used in 1,7/22 patients, although 4 required conversion to intravenous anesthesia due to hemodynamic compromise. Despite these anesthetic transitions, ventilatory parameters, including EtCO₂, PIP, and tidal volume, remained stable, with only modest increases in FiO₂ requirements.
Conclusion:
PFR deployment results in stable ventilatory physiology and predictable saturation and hemodynamic responses. These findings provide practical anesthetic guidance and characterize the intra-procedural physiology of this emerging palliation strategy.