Anesthesia for Noncardiac Surgery in Pediatric Patients Following Cardiac Transplantation

Abstract

Pediatric cardiac transplantation has been performed with increasing frequency to treat hypoplastic left heart syn drome and other types of congenital heart disease. A large number of these patients will require anesthesia posttrans plantation for noncardiac surgery. A review of our series of 92 anesthetics in 46 patients has better defined periopera tive risk factors, anesthetic management, common surgical procedures, and complications associated with noncardiac surgery in posttransplantation patients. Anesthetic manage ment concerns include allograft coronary artery disease, graft rejection, denervation, cardiac dysrhythmias, immuno suppression, cyclosporine-induced hypertension, drug inter actions, renal dysfunction, and intravenous access prob lems. Preoperative evaluation must include the possibility and definition of these problems. Medically stable patients undergoing noncardiac/nonthoracic surgery after cardiac transplantation undergo the same surgical procedures as similarly aged nontransplantation patients. Similar induc tion techniques can be used as in nontransplantation pa tients. These patients may also be scheduled for same-day surgery if other significant medical problems are not present and the difficulty of the surgery is compatible with an out patient setting. Patients with more complex medical prob lems, including chronic rejection, significant coronary artery disease, or a history of congestive failure may need over night monitoring in a hospital setting despite that only a minor surgical procedure is being performed.