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Surgery on Children

Surgery on Children Journal aims to publish issues related to Pediatric Surgery, Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Cardiovascular Surgery, Pediatric Orthopedic Surgery, Pediatric Vascular Surgery, Pediatric Gynecology and Obstetrics, Pediatric Ear Nose Throat, Ophthalmology, Pediatric Anesthesiology and Reanimation, Pediatric Urology, Pediatric Surgical Intensive Care Clinic, and other clinical surgery fields on children of the highest scientific and clinical value at an international level and accepts articles on these topics.

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Anesthetic management in pediatric cardiac surgery
Abstract
Pediatric cardiac anesthesia poses significant challenges due to the complexity of congenital heart diseases (CHDs) and the distinct physiological considerations in children. Despite advancements in surgical and anesthetic techniques, many regions still struggle to provide adequate cardiac care, while some areas perform a high volume of pediatric cardiac surgeries annually. This review explores the development and physiology of the cardiovascular system, focusing on congenital heart defects and their impact on anesthesia management. It discusses the roles of cardiopulmonary bypass (CPB) and cardiac catheterization in diagnosis and treatment, as well as essential aspects of preoperative, intraoperative, and postoperative care. Emphasis is placed on effective anesthesia strategies, early extubation, and optimal recovery practices. Ongoing advancements in technology and clinical practice are vital for enhancing safety and outcomes in pediatric cardiac anesthesia.

Keywords : Anesthesia, cardiac, pediatric, congenital heart disease, cardiopulmonary bypass

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1. Hodges SC, Walker IA, Bosenberg AT. Paediatric anaesthesia in developing countries. Anaesthesia. 2007;62(Suppl 1):26-31. doi:10.1111/j. 1365-2044.2007.05294.x
2. Yacoub MH. Establishing pediatric cardiovascular services in the developing world: a wake-up call. Circulation. 2007;116(17):1876-1878. doi:10.1161/CIRCULATIONAHA.107.726265
3. Yüzkat N, Çeğin MB, Polat V, Soyoral L, Göktaş U, Kunt AS. Pediyatrik Konjenital Kalp Cerrahisinde Anestezi Deneyimlerimiz: İlk Sonuçlar. GKDA Derg. 2015;21(4):168-173. doi:10.5222/GKDAD.2015.168
4. Tchervenkov CI, Jacobs JP, Bernier PL, et al. The improvement of care for paediatric and congenital cardiac disease across the world: a challenge for the World Society for Pediatric and Congenital Heart Surgery. Cardiol Young. 2008;18(Suppl 2):63-69. doi:10.1017/S1047951108002801
5. Raj N. Regional anesthesia for sternotomy and bypass-beyond the epidural. Paediatr Anaesth. 2019;29(5):519-529. doi:10.1111/pan.13626
6. Faraoni D, Zurakowski D, Vo D, et al. Post-operative outcomes in children with and without congenital heart disease undergoing noncardiac surgery. J Am Coll Cardiol. 2016;67(7):793-801. doi:10.1016/j.jacc.2015.11.057
7. Kussman BD, Miller-Hance WC. Development of the cardiovascular system and nomenclature for congenital heart disease. In: Dean B, Stayer S, Emad B, Wanda C, eds. Anesthesia for Congenital Heart Disease. 3rd ed. Houston: Wiley Online Library; 2015.
8. Remien K, Majmundar SH. Physiology, fetal circulation. StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539710/
9. Nasr VG, DiNardo JA. Cardiopulmonary bypass. In: The Pediatric Cardiac Anesthesia Handbook. 1st ed. New York: John Wiley & Sons; 2017.
10. Ma J, Li XH, Yan ZX, Liu AJ, Zhang WK, Yang LN. Effect of myocardial protection during beating heart surgery with right sub-axiliary approach. Chin Med J (Engl). 2009;122(2):150-152. doi:10.3760/cma.j. issn.0366-6999.2009.02.007
11. Öygen Ö, Salık F. Pediatrik kardiyak anestezi. In: Haspolat YK, Baysal Yıldırım Z, eds. Pediatrik Anestezi. 1st ed. Ankara: Türkiye Klinikleri; 2023.
12. Nasr VG, Markham LW, Clay M, et al. Perioperative considerations for pediatric patients with congenital heart disease presenting for noncardiac procedures: a scientific statement from the American Heart Association. Circ Cardiovasc Qual Outcomes. 2023;16(1):e000113. doi:10. 1161/HCQ.0000000000000113
13. Junghare SW, Desurkar V. Congenital heart diseases and anaesthesia. Indian J Anaesth. 2017;61(9):744-752. doi:10.4103/ija.IJA_415_17
14. Kiski D, Malec E, Schmidt C. Use of dexmedetomidine in pediatric cardiac anesthesia. Curr Opin Anaesthesiol. 2019;32(3):334-342. doi:10. 1097/ACO.0000000000000731
15. Faritus SZ, Khazaee-Koohpar M, Ziyaeifard M, Mehrabanian MJ. Oral dexmedetomidine versus midazolam as anesthetic premedication in children undergoing congenital heart surgery. Anesth Pain Med. 2015; 5(3):e25032. doi:10.5812/aapm.5(3)2015.25032
16. Huang Q, Lin LY, Lin XZ. Comparison of remifentanil-based fast-track and fentanyl-based routine cardiac anesthesia for intraoperative device closure of atrial septal defect (ASD) in pediatric patients. Med Sci Monit. 2019;25:1187-1193. doi:10.12659/MSM.913387
17. Amer GF, Elawady MS, ElDerie A, Sanad M. Normothermia versus hypothermia during cardiopulmonary bypass in cases of repair of atrioventricular septal defect. Anesth Essays Res. 2020;14(1):112-118. doi: 10.4103/aer.AER_123_19
18. Xiong T, Pu L, Ma YF, et al. Safety of normothermic cardiopulmonary bypass in pediatric cardiac surgery: a system review and meta-analysis. Front Pediatr. 2021;9:757551. doi:10.3389/fped.2021.757551
19. Baehner T, Kiefer N, Ghamari S, et al. A national survey: current clinical practice in pediatric anesthesia for congenital heart surgery. World J Pediatr Congenit Heart Surg. 2020;11(3):257-264. doi:10.1177/ 2150135120902122
20. Padala S, Badhe AS, Parida S, Jha AK. Comparison of preincisional and postincisional parasternal intercostal block on postoperative pain in cardiac surgery. J Card Surg. 2020;35(7):1525-1530. doi:10.1111/jocs. 14651
21. Bloc S, Perot BP, Gibert H, et al. Efficacy of parasternal block to decrease intraoperative opioid use in coronary artery bypass surgery via sternotomy: a randomized controlled trial. Reg Anesth Pain Med. 2021; 46(8):671-678. doi:10.1136/rapm-2020-102207
22. Yamamoto T, Schindler E. Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery. Curr Opin Anaesthesiol. 2023;36(3):324-333. doi:10.1097/ACO.0000000000001262
23. Demir AZ, Ozgok A, Balci E, Karaca OG, Şimşek E, Günaydin S. Preoperative ultrasound-guided bilateral thoracic erector spinae plane block within an enhanced recovery program is associated with decreased intraoperative lactate levels in cardiac surgery. Perfusion. 2024;39(2):324-333. doi:10.1177/02676591221140754
24. Rizza A, Romagnoli S, Ricci Z. Fluid status assessment and management during the perioperative phase in pediatric cardiac surgery patients. J Cardiothorac Vasc Anesth. 2016;30(4):1085-1093. doi:10.1053/j.jvca.2015. 11.007
25. Mittnacht AJC, Shariat A, Weiner MM, et al. Regional techniques for cardiac and cardiac-related procedures. J Cardiothorac Vasc Anesth. 2019;33(2):532-546. doi:10.1053/j.jvca.2018.09.017
26. Mahle WT, Jacobs JP, Jacobs ML, et al. Early extubation after repair of tetralogy of Fallot and the Fontan procedure: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg. 2016;102(3):850-858. doi:10.1016/j.athoracsur.2016.03.013
27. Ovroutski S, Kramer P, Nordmeyer S, et al. Early extubation is associated with improved early outcome after extracardiac total cavopulmonary connection independently of duration of cardiopulmonary bypass. Eur J Cardiothorac Surg. 2018;54(5):953-958. doi:10.1093/ejcts/ezy179
28. van der Griend BF, Lister NA, McKenzie IM, et al. Postoperative mortality in children after 101,885 anesthetics at a tertiary pediatric hospital. Anesth Analg. 2011;112(6):1440-1447. doi:10.1213/ANE. 0b013e318213be52
29. Stein ML, Bilal MB, Faraoni D, et al. Selected 2022 highlights in congenital cardiac anesthesia. J Cardiothorac Vasc Anesth. 2023;37(7): 1095-1100. doi:10.1053/j.jvca.2023.03.032
30. Schertz K, Karam O, Demetres M, Mayadunna S, Faraoni D, Nellis ME. Prophylactic use of antifibrinolytics during pediatric cardiac surgery with cardiopulmonary bypass on postoperative bleeding and transfusion: a systematic review and meta-analysis. Pediatr Crit Care Med. 2022;23(11):e517-e529. doi:10.1097/PCC.0000000000003049
31. Murni IK, Djer MM, Yanuarso PB, et al. Outcome of pediatric cardiac surgery and predictors of major complication in a developing country. Ann Pediatr Cardiol. 2019;12(1):38-44. doi:10.4103/apc.APC_146_17
Article available in :
Volume 2, Issue 2, 2025
Page : 66-71
https://doi.org/10.51271/SOC-0038
Article Information
Received : 18 Eyl 2024
Accepted : 27 Eki 2024
Published : 10 Nis 2025
Corresponding Author :

Ayşe Gizem Saraçoğlu: Department of Anesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Turkiye

[email protected]
Citation : Saraçoğlu AG, Salman N. Anesthetic management in pediatric cardiac surgery. Surg Child. 2025;2(2):66-71.

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