A child with congenital heart disease: A challenge for Anesthesiology

The EACTAIC Education Committee has organized the seminar episode in collaboration with the Mothers and Child Centre, Medical Faculty of the University of Bonn, Germany.

The Mothers and Child Centre, Medical Faculty of the University of Bonn, Germany supported this seminar episode.

Learning Objectives:

At the end of this seminar episode, you will be able to

– Understanding the unique aspects of preparation and induction for anesthesia in children with congenital heart defects.

– Recognise the feasibility of on-table extubation after pediatric congenital heart surgery

– Describe the different malformations and questions to be asked the parents for detailed history taking through a case discussion.

– Recall about using vasopressor therapy in pediatric congenital heart surgery.

IMPORTANT: If you do not receive your link 48 hours after the registration, please contact eactaic@iameetings.sg. Registrations will be accepted until 17.25 of April 22nd. All the registrations sent after that time, will not be accepted.

Programme:
Time Topic Speaker
18:00–18:05 Opening word of the hosting centre Ehrenfried Schindler
18:05–18:07 Poll (1) —
18:08–18:23 We need a plan. Preparation for Anesthesia Josefin Grabert
18:23–18:25 Poll (2) —
18:26–18:41 On table extubation in cardiac surgery – feasible and safe? Marc Rohner
18:41–18:43 Poll (3) —
18:44–19:01 Vasopressors in congenital heart surgery Ehrenfried Schindler
19:02–19:12 Unexpected problems during dental surgery — A case report Guido Kliemann
19:13–19:33 Q&A The Faculty
19:33–19:35 The Take Home Message Ehrenfried Schindler
19:35–19:40 EACTAIC Education Chair Closing Words Mohamed El Tahan


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Event Details
10
Days
50
Hours
10
Min
00
Sec
Start Date
April 22, 2024 6:00 pm
End Date
April 22, 2024 7:40 pm
Status
Expired

yes. loading as you said. Milrinone is used frequently

we tried thoracic wall blocks with inferior results. in ISTHA or lateral thoracotomy we use intercostal blocks done by the surgeon prior extubation Please read the work of PA Lonnqvist from Sweden: Daring discourse: should the ESP block be renamed RIP II block? Very interesting!!

Fentanyl only for induction. usually 50 mcg to 100 mcg (high dose, I know!) followed immediatly by remifentanil 0.4-0.5 mcg/kg/min

For the peds we use DEX in 1 ug/kg/hr. No loading or bolus. Starting after coming of bypass

No. Midazolam 0.5 mg/kg (max 15 mg)

in Peds? ABSOLUTLEY

Just to be sure: The PDA stent is done in the Cath Lab, right? these Pat are only sedated in our institution. in all others, is possible but heses are usually a few because the majority nowadays are early corrected. the others are usually small an in newborn age. Its possible but more challenging. All others possible and is done so

no. U can use the pump for that? with hemofiltration

the question goes to the audience, I guess. We don’t do that because the duration of caudal in newborns is not so long (app 1h, with 1 ug/kg clonidine maybe 1,5h-2)

in those patients positive pressure ventilation is reducing shunt flow. Spontaneous breathing will promote shunt flow.

yes. it’s nice in newborns and important. I didn’t mention it because it’s not acting as vasopressor

Thanks for the question. Most of the non-Germans are not knowing this drug because its soley used in Germany. It’s a "dirty drug" because its acting differently in different doses. Jens, we are only rarely using it in congenital heart disease Pat. If using it we dilute 1 ampula in 10 ml an start with tiny pushes against the syringe... (I guess like you do?!)

nearly the same as those with RV dysfunction due to PHT. We start with norepinephrine 0.05-0.1 ug/kg/min and dont let the the CVP drop

no. not in Pediatrics

0.2 mg/kg 30´before extubation

I am not aware of evident data supporting this. At our center we successfully work in mixed teams on cardiothoracic PICU since several years (and we both learn so much from each other…)

In adult patients we normally use a much lower dose of 0.25-0.5 mcg/kg/h without bolus. I found higher dosed patient tend to be to much sedated, when it comes to OTE (normally performed 10-15 min after skin closure)

it is not common in Germany to use morphine infusions, due to the long context-sensitive halftime. To stay in my picture: the good, the bad and the slooowwww. it would be my last choice for Fast-track

to be honest: first we did, we stoped the use of dex in adult ctva. But after looking more closely on the data it is obvious, that the statment cant be held for our patients (postoperative, propably not so chronical ill) and in the spice III trial the dex group was deeper sedated than the control group. So: right now we use it on a regular basis

it works for sure. i don’t use it therefore, but i surely use the side effect on purpose. Typical situation: difficult weaning from CPB, increase of catecholamines, giving Thorombocytes and GFP -> giving Ca++….

we don’t use it at all in adult CV anesthesia: normally we have to address vasodilatation and restore coronary perfusion. when it comes to the need of inotropes Akrinor is not potent enough (for CV cases !!)

in adults: typically balanced anesthesia with sufentanil and sevoflurane and +/- dexmedetomidine the nice thing about sufentanil is the longer lasting sedative effect

paediatric patients Dex + Morphine (Piritramid) adult patients Sufentanil, sometimes Clonidine

Yes we extubate ACHD patients on table, extubation criteria similar to our other paediatric and adult patients

We often start it at the beginning of weaning from bypass

we use often vasopressin 0.0003units/kg, when hypotension with milrinone or levosimendan loading, to improve MAP with promising results. what is your experience?