Heart Disease For Non-cardiac Surgery Research Articles

G351 Outcome of non-cardiac surgery in children with congenital heart disease performed outside a cardiac centre

BackgroundApproximately 30% of children with congenital heart disease (CHD) require surgery within the first year of life for extracardiac anomalies. CHD increases short- and long-term mortality risks for non-cardiovascular procedures1....

Perioperative Care of Adults with Congenital Heart Disease for Non-cardiac Surgery

In 2010 it was estimated that 1.2 million young adults in the United States have some form of congenital heart disease (CHD). Data from large adult congenital heart disease (ACHD) centers show that as many as 50 % of these patients are over 40 years of age. As this population ages, physicians are likely to encounter such patients in their practice. Risk stratification and an interdisciplinary approach are paramount in achieving safe outcomes. The assessment of the patient must consider the variable expression of CHD. As most lesions are “fixed but not cured” the altered physiology of the heart and the physiological challenges of surgical interventions must be considered. The 2008 AHA/ACC guidelines for the Management of Adults with CHD establish for the first time a streamlined approach to the care of these patients. This review will apply these guidelines to the ACHD patient undergoing non-cardiac surgery.

Anaesthetic management of children with congenital heart disease for non-cardiac surgery

Congenital heart disease (CHD) is the most common birth defect, occurring in approximately one in 125 live births. Advances in medical care have led to 90% of these children surviving to adulthood. Children with CHD are subject to the same childhood illnesses as healthy children and therefore present to their local hospital requiring both elective and emergency surgery. In general, children with CHD undergoing non-cardiac surgery have an increased risk of morbidity, perioperative cardiac arrest, and a higher 30 day mortality. – 6 However, the complexity of cardiac defects and the variety of non-cardiac surgery make it impossible to generalize. A 9-yr-old child with a repaired atrial septal defect (ASD) who requires an emergency appendicectomy presents minimal risk; yet, a 12-yr -old with a failing single-ventricle circulation for the same operation presents a significant challenge even to the most experienced paediatric cardiac anaesthetist.

Approach to managing children with heart disease for noncardiac surgery

Congenital heart disease is the commonest birth defect, and advances in modern medicine mean 90% of these children now survive to adulthood. Therefore, many children present to their local hospital requiring general anesthesia for common childhood conditions. They pose a challenge for anesthesia because perioperative morbidity and mortality is greater compared with other children. It is impossible to prescribe a formula for anesthetizing children with heart disease because of the complexity of heart defects and the variety of noncardiac surgery. There is also a lack of high-quality data of efficacy of one anesthetic technique over another. Much data come from case series or isolated case reports. In a rapidly advancing field such as cardiac surgery, studies of long-term complications may be out of date by the time they are published, limiting applicability of the results. Because of these factors, claims of efficacy and safety of various approaches to managing children with heart disease for noncardiac surgery must be interpreted cautiously. This narrative review aims to present the evidence concerning a range of anesthetic techniques, the long-term complications of congenital heart disease and suggest a physiological and evidence-based approach to managing these children.

Anaesthetic management of the child with congenital heart disease for non-cardiac surgery.

Most children with congenital heart disease can be man-aged safely if the pathophysiology of their lesion and the anaesthetic implications are understood. However, recent reviews of anaesthetic morbidity reveal a high incidence of anaesthetic-related adverse events in children with congenital heart disease.

Anaesthesia for patients with congenital heart disease.

The management of patients with congenital heart disease for non-cardiac surgery requires an understanding of the pathophysiology involved in the lesion and the residual effects of any corrective or palliative surgery performed in the past. Selection of anaesthetic techniques that do not adversely affect the cardiac status, meticulous technique, and appropriate monitoring will allow a successful conclusion to virtually any anaesthetic and operative procedure.

Anaesthesia for cardiac patients having non-cardiac operations

It is difficult to pick out a sensitive marker for the effectiveness with which patients with heart disease have been managed for non-cardiac operations. Reinfarction rates have frequently been cited for this purpose over the past 20 years and it is interesting and perplexing that, until very recently, we have been unable to show significant decreases in reinfarction rates in patients who have had a myocardial infarction within six months of surgery. It has been our opinion for a number of years that, in general, patients with heart disease are well managed in the intraoperative phase of their hospital stay. The successful management of patients during this period is based on the fact that the majority of anaesthetists now appear to have a good understanding of the pathophysiology of heart disease and are becoming more aggressive in the monitoring and treatment of abnormal haemodynamics when they occur. The ultimate extent to which morbidity and mortality can be reduced in patients with heart disease for non-cardiac surgery will not be known until patients at high risk receive the same intensive postoperative care that patients who undergo heart surgery enjoy. It is the fact that patients are haemodynamically stable and do not have myocardial ischaemia throughout the peri-operative period that is important, rather than the way in which it is achieved.

Optimal management of patients with ischemic heart disease for noncardiac surgery by complementary anesthesiologist and cardiologist interaction

Patients with ischemic heart disease (IHD) constitute a considerable percentage of those undergoing anesthesia and surgery in our population. These patients comprise the spectrum from occult coronary artery disease (CAD) to severe disabling angina pectoris with little cardiac reserve. Often, at the time of noncardiac surgery, a diagnosis of the specific type or exact extent of cardiac disease is not available. Frequently, these patients have many associated disorders including diabetes mellitus, hypertension, cerebrovascular disease, peripheral vascular disease, chronic obstructive pulmonary disease, and/or congestive heart failure (CHF). Much has been reported concerning patients undergoing surgical myocardial revascularization (CABG) and their requirements for careful preoperative evaluation, perioperative monitoring, and postoperative intensive care.’ However, the patient for noncardiac surgery is often older and much sicker with diffuse inoperable CAD. Since the IHD patient undergoing noncardiac surgery does not receive the benefit of CABG, such perioperative care is critical to reduce morbidity and mortality. Unfortunately, there may often be insufficient communication between the patient’s cardiologist and anesthesiologist. A principal objective of this presentation is to provide improved understanding of the anesthesiologist’s role throughout the perioperative period, for the cardiologist to gain enhanced insight into the information needed by the anesthesiologist, and the manner by which the patient is managed. To more clearly demonstrate the interaction between the two specialists, an exemplifying clinical

Management of patients with heart disease for noncardiac surgery

Management of patients with heart disease for noncardiac surgery