Related Experiment Videos
The anaesthetic management of the child with Eisenmenger's syndrome
B Lyons1, C Motherway, W Casey
1Department of Anaesthesia, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Pediatric patients with Eisenmenger syndrome can safely undergo non-cardiac surgery with various anesthetic techniques. This review of 11 procedures found that anesthetic management was generally well-tolerated, with minimal complications.
Area of Science:
- Anesthesiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Limited data exists on anesthetic management for pediatric patients with Eisenmenger syndrome undergoing non-cardiac surgery.
- Eisenmenger syndrome presents significant anesthetic risks due to pulmonary hypertension and right-to-left shunting.
Purpose of the Study:
- To review anesthetic management and outcomes in pediatric patients with Eisenmenger syndrome undergoing non-cardiac procedures.
- To assess the safety and feasibility of different anesthetic techniques in this high-risk population.
Main Methods:
- Retrospective review of 11 non-cardiac surgical procedures in 8 pediatric patients with Eisenmenger syndrome.
- Analysis of anesthetic techniques, including premedication, induction, maintenance, monitoring, and postoperative analgesia.
- Categorization of procedures into minor (dental, plastic, ENT) and major (laparotomies).
Main Results:
- Most patients (6/8) had Down syndrome with atrioventricular septal defects.
- Anesthetic techniques varied, including inhalational and intravenous agents; spontaneous respiration was common for minor procedures.
- Major procedures involved mechanical ventilation and invasive monitoring; postoperative analgesia included epidural infusions and opioids.
- All patients tolerated anesthesia well, with only one episode of bradycardia reported.
Conclusions:
- Pediatric patients with Eisenmenger syndrome can tolerate a range of anesthetic techniques for non-cardiac surgery.
- Careful anesthetic planning and monitoring are crucial for optimizing outcomes in these complex patients.
Abstract:
There is little clinical data in the literature on the anaesthetic management of paediatric patients with Eisenmenger's syndrome undergoing non-cardiac surgery. This paper reviews our experiences with either such patients who underwent a total of 11 surgical procedures. Of the eight children, six had Down's syndrome and an atrio-ventricular septal defect, one had a ventricular septal defect and one an atrial septal defect. Nine of the eleven operations consisted of minor dental, plastic or ENT procedures, while one patient underwent two laparotomies. Premedication (trimeprazine/ meperidine combination or midazolam) was administered on three occasions. Induction of anaesthesia was achieved by either inhalation of halothane (2), or intravenously with thiopentone (6), ketamine (2) or propofol (1). Muscle relaxation and mechanical ventilation were employed only for both intra-abdominal procedures, otherwise patients were allowed to breathe spontaneously with, or without, manual assistance. Halothane (8), isoflurane (2) and enflurane (1) were all used for maintenance of anaesthesia. Non-invasive monitoring was applied intraoperatively for minor procedures, and arterial and central venous catheters inserted for the laparotomies. Postoperative analgesia for both these cases was provided by an epidural infusion of bupivacaine 0.125% and fentanyl 5 micrograms x ml(-1). A single im bolus of morphine was required following a dental clearance, otherwise pain relief for the rest of the cases was achieved by local anaesthetic infiltration and NSAIDS. With the exception of a single episode of bradycardia, induction, maintenance and recovery from anaesthesia were well tolerated in all cases. In conclusion, our experience suggests that despite theoretical risks, children with Eisenmenger's syndrome appear to tolerate a variety of anaesthetic techniques.