Anesthetic management for palliative arterial switch operation

Abstract

Objective To summarize the anesthetic management experience for palliative arterial switch operation (PASO). Methods Twenty-eight patients who suffered from transposition of the great arteries(TGA) with septal ventricular defect (TGA/VSD) or Taussing-Bing syndrome underwent PASO were reviewed. The median age was 4 y (ranging from 1 month to 25 y) and the median body weight was 12.5 kg(ranging from 3.6 kg to 43 kg). ALL of them were diagnosed with severe pulmonary hypertension preoperatively. Their preoperative SpO2 was fluctuated from 44% to 91%. Results All anesthetic procedures went smoothly. The mean CPB time was (223± 81) min and the mean cross-clamp time was (153±32) min. The mean size of fenestration in VSD patch was (5.3±1.5) mm. The median postoperative mechanical ventilation time and stay length in intensive care unit was 36 h (ranging from 7 h to 408 h) and 5.5 d (ranging from 2 d to 27 d), respectively. The mean postoperative SpO2 increased significantly to 96% (P<0.05). The mortality rate was 18%. The fenestrations in 5 patients were closed interventionally during 1-5 y after hospital discharge. Conclusions The success of PASO depends on adequate preoperative assessment and preparation, stabel anesthesia induction, management of perioperative pulmonary hypertension and the early and rational administration of cardiovascular drugs, and the adjustment of hemostatic function. Key words: Transposition of the great arteries; Palliative arterial switch operation; Anesthetic management