Pediatric Cardiac Anesthesia Research Articles

Selected 2023 Highlights in Congenital Cardiac Anesthesia

This article reviews the highlights of pertinent literature of interest to the congenital cardiac anesthesiologist published in 2023. Following a search of the United States National Library of Medicine PubMed database, several topics emerged where significant contributions were made in 2023. The authors of this manuscript considered the following topics noteworthy to be included in this review: Advancements in percutaneous mechanical support in children with CHD, children with pulmonary hypertension undergoing surgery for congenital heart disease (CHD), Dexmedetomidine in pediatric cardiac surgery, and recommendations for pediatric heart surgery in the United States: Implications for pediatric cardiac anesthesia

European Pediatric Cardiac Anesthesia Fellowship Program: A First Proof of Concept

The Pediatric Cardiac Anesthesia Fellowship is a demanding training program in Europe and the United States. Successful completion of the program requires years of training in anesthesiology, a thorough understanding of cardiovascular anatomy and physiology, and extensive experience in the perioperative management of neonates and children with heart disease. In the context of the first candidate to successfully complete the PCA program in Europe, this article presents excerpts from the design and structure of the European PCA program. The PCA program is critically evaluated by both external and internal reviewers, and points are highlighted that could be included in the next version of the program.

Pediatric Cardiac Anesthesia Training and Staffing in the National Health Service.

Considerable importance is attached to the process of training, appointing and retaining highly specialized pediatric anesthetists, such as those with a congenital heart disease practice. For the 10-year period from April 2012 to March 2022, we wished to establish changes in the absolute number of consultant pediatric cardiac anesthetic posts in NHS Level 1 Centres, turnover in such posts, and what training appointees had received. An email survey was sent to the Centre Representative from the Congenital Cardiac Anesthesia Network in each of the eleven NHS Level 1 Pediatric Congenital Heart Disease Centre. Further follow up was completed in order to confirm accuracy of responses. We defined a pediatric cardiac anesthetist as a consultant with a clinical practice including provision of anesthetic management for children undergoing cardiac surgery incorporating the use of cardiopulmonary bypass. The response rate to our survey was 100%. Over the study period the number of consultants increased from 69 to 81, though three posts were unfilled as at March 2022. There were 55 departures and 65 appointees. Five consultants moved between NHS Units. 52 consultants received formal fellowship training and 13 switched into pediatric cardiac anesthesia from an existing general pediatric anesthetic post, with a period of supplementary training within their institution. Appointees reported extensive additional training variably including fellowships in general pediatric anesthesia, adult cardiac anesthesia and pediatric intensive care, both within and outside the United Kingdom. There has been both an expansion in the number of posts, as well as considerable turnover in consultant posts in the last 10 years. Training standards which support and guide individuals as they develop a practice in this highly specialized field should reflect different routes into the speciality and could be established with the support and advice of the Congenital Cardiac Anesthesia Network.

Editorial introductions.

Editorial introductions.

Evaluation of YouTube Videos Quality of Pediatric Cardiac Surgery Anesthesia

Evaluation of YouTube Videos Quality of Pediatric Cardiac Surgery Anesthesia

Selected 2022 Highlights in Congenital Cardiac Anesthesia

This article is a review of the highlights of pertinent literature of interest to the congenital cardiac anesthesiologist, and was published in 2022. After a search of the United States National Library of Medicine PubMed database, several topics emerged in which significant contributions were made in 2022. The authors of this manuscript considered the following topics noteworthy to be included in this review-intensive care unit admission after congenital cardiac catheterization interventions, antifibrinolytics in pediatric cardiac surgery, the current status of the pediatric cardiac anesthesia workforce in the United States, and kidney injury and renal protection during congenital heart surgery.

Current Anesthesia Practices of Pediatric Cardiac Surgeries in Tertiary Maternity and Children's Hospitals in China: A National Survey

To describe the current development of Chinese pediatric cardiac anesthesia practices. Descriptive research study. This study used electronic questionnaires. The authors searched the official website of the National Health Commission of the People's Republic of China for tertiary maternity and children's hospitals across the country. Tertiary maternity and children's hospitals. All representatives of the invited hospitals were asked to report the official statistics of their hospitals whenever possible. The survey questions were related to the geographic distribution and caseloads of pediatric cardiac surgical resources, technical capacities, anesthetic regimens, monitoring practices, and qualification requirements of anesthesiologists. A total of 130 hospitals were confirmed, using the registration information of the National Health Commission of the People's Republic of China, and 108 hospitals agreed to participate in this study. All enrolled hospitals completed the questionnaires, of which 52 could perform cardiac surgeries and were located in provinces, autonomous regions, and municipalities across the country, except for the Inner Mongolia Autonomous Region, Ningxia Hui Autonomous Region, and Tibet Autonomous Region. The authors found that most hospitals' caseload of pediatric cardiac surgeries was relatively small (<500 cases per year). Hospitals capable of performing high-risk pediatric cardiac surgeries are mainly located in Eastern China. Most hospitals prefer total intravenous anesthesia in cardiac surgeries, and commonly used anesthetics include propofol, sufentanil, rocuronium, and cisatracurium. Except for the basic intraoperative monitoring items (including electrocardiography, invasive blood pressure, central venous pressure, pulse oxygen saturation, intake-output volume, and body temperature), bispectral index and near-infrared spectroscopy are relatively commonly used in some hospitals. Postoperative analgesia for children undergoing cardiac surgeries was provided in 38 hospitals, and an intravenous analgesia pump was the most widely used analgesia measure. In addition, the most frequently mentioned qualification requirements for pediatric cardiac anesthesiologists in these hospitals specializing in cardiac surgeries were a further study in domestic hospitals specializing in cardiac surgeries and the professional titles of the attending doctors. Pediatric cardiac medical resources are mainly concentrated in Eastern China, and most hospitals capable of performing high-risk cardiac surgeries are located in the eastern part of the country. The authors found that pediatric cardiac anesthesia practices varied widely among the hospitals, and the main problem with pediatric cardiac anesthesia in China is that there is no systemic fellowship training curriculum at present; therefore, there is an urgent need to develop a fellowship training curriculum to further improve the quality of Chinese pediatric cardiac anesthesia.

Adverse Events in the Pediatric Cardiac Catheterization Suite: Does Having Pediatric Cardiac Anesthesiologists Make a Difference?

It has been suggested that anesthesiologists with subspecialty expertise in pediatric cardiac anesthesia are best qualified to care for patients with complex congenital cardiac anomalies and manage the complex physiology frequently encountered in the pediatric cardiac catheterization lab. We evaluated the incidence of adverse events in our pediatric cardiac catheterization lab, comparing care provided by cardiac and noncardiac pediatric attending anesthesiologists. Data were collected on each anesthetic in the pediatric cardiac catheterization lab from January 1, 2016 to December 31, 2019. A generalized linear mixed effect model was used to identify associations between pediatric cardiac and noncardiac anesthesiologists and the presence of adverse events adjusting for age, American Society of Anesthesiologists physical status, emergency status, and interventional versus diagnostic procedures. A total of 3,761 procedures involving 1,729 patients were included in the study. There was no significant difference between noncardiac and cardiac anesthesia attendings for overall adverse events (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.82 to 1.75 P=0.349). Specific respiratory adverse events (OR, 1.22; 95%, CI 0.73 to 2.03 P=0.443) or cardiac adverse events (OR, 1.26; 95% CI, 0.64 to 2.48 P=0.502) were also not significantly different with respect to noncardiac compared with cardiac attending anesthesiologists. In our analysis, the incidence of adverse events in the pediatric cardiac catheterization lab during the study period was not statistically different, whether anesthesia care was provided by a cardiac or a noncardiac anesthesiologist.

Simulation Based Mastery Learning of Transesophageal Echocardiography.

Transesophageal echocardiography (TEE) education is part of pediatric cardiology fellow training. Simulation-based mastery learning (SBML) is an efficient and valuable education experience. The aim of this project was to equip trainees with the basic knowledge and skill required to perform a pediatric TEE. The secondary aim was to assess the utility of using SBML for pediatric TEE training. The target group is trainees from pediatric cardiology and cardiac anesthesia who participated in a TEE bootcamp. A baseline knowledge pretest was obtained. The knowledge session consisted of preparation via reading material, viewing recorded lectures and completing an iterative multiple-choice examination, which was repeated until a minimum passing score of 90% was achieved. The skills session involved a review of TEE probe manipulation and image acquisition, followed by rapid cycle deliberate practice using simulation to acquire TEE skills at 3 levels, advancing in complexity from level 1 to level 3. Eight individuals (7 pediatric cardiology fellows at varying training levels and one anesthesia attending) participated in the TEE bootcamp. All reached a minimum knowledge post test score of at least 90% before the skills session. All subjects reached mastery in TEE probe manipulation. All reached mastery in image acquisition for the skill level that they attempted (level 1-8/8, level 2-8/8, level 3-4/4, with 4 participants not attempting level 3). ATEE bootcamp using SBML is a powerful medical education strategy. SBML is a rigorous approach that can be used to achieve high and uniform TEE learning outcomes among trainees of different training levels and backgrounds.

Paediatric Cardiac Anaesthesia at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria: The Hurdles, Struggles, and Successes

Background: Open-heart surgery started at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria, 5 years ago through partnership with foreign partners. This paper reviewed the difficulties facing the development of paediatric cardiac anaesthesia, the pattern, and the outcome of cases managed.&#x0D; Methods: A review of the infrastructure, equipment, manpower and operational setup for open-heart surgery at OAUTHC was done. A retrospective study of all patients that were operated on from April 2016 to March 2021 was performed. Extracted data were analysed with Statistical Packages for the Social Scientists using descriptive statistics.&#x0D; Results: A total of 102 patients had open-heart surgeries during the period under review by the various teams in a shared facility of the hospital's main theatre. Challenges with manpower, infrastructure, and supplies were major limitations to service delivery. Most of the patients (75.5%) were aged &lt; 5 years. The commonest procedures performed were ventricular septal defect closure (31.4%), total correction of tetralogy of Fallot (26.5%), and atrial septal defect closure (9.8%). Fast-tracked anaesthesia was used always except where it was contraindicated. Most (76.7%) of the cases were extubated within 24 hours after surgery; the mean (SD) duration of ventilation in the ICU was 0.99 (1.2) days and the average length of ICU stay was 3 days. The overall mortality rate was 20.6%.&#x0D; Conclusion: Numerous challenges confront the provision of sustainable paediatric cardiac anaesthesia services in resource-constrained settings like ours. Much can be achieved with appropriate investment in material and manpower, and partnership with experienced teams.&#x0D; Authors&#x0D; A T Adenekan 1, A M Owojuyigbe 1, O I Aaron 1, O O Ojo 2

Editorial introductions.

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Editors of the journal and the Section Editors for this issue. SECTION EDITORS Jill MhyreJill MhyreJill Mhyre is The Dola S Thompsom Professor and Chair of Anesthesiology at the University of Arkansas for Medical Sciences, Arkansas, USA. She is Executive Section Editor of Obstetric Anesthesiology for Anesthesia & Analgesia, and Associate Editor for the textbook, Chestnut's Obstetric Anesthesia: Principles & Practice. Her academic interests include maternal safety systems such as early warning systems, cardiopulmonary resuscitation, and morbidity and mortality. Christiane BeckChristiane BeckDr Christiane Beck is the leading senior consultant at the Clinic of Anesthesiology and Intensive Care Medicine at Hannover Medical School, Germany. She has studied medicine at the Universities of Göttingen, Germany, Johannesburg, South Africa, and Madison, USA. She received her degree in 1997 from the University of Göttingen, Germany. She completed her anesthesiology residency training in 2003 and is a certified anesthesiologist, intensivist and emergency physician. She achieved her doctoral degree at the Center for Radiologic Diagnostics, University of Göttingen, Germany in 2000. Dr Christiane Beck habilitated in 2021 at the Hannover Medical School, Germany. Besides clinical duties, she implemented and coordinates to date preoperative fasting guidelines for children. She is co-author of the actual ESAIC Fasting Guideline and coordinator of the German fasting guidelines on this subject. She specializes in pediatric anesthesia, anesthesia for complex congenital cardiac surgery and transplant surgery in children. She is a member of the German Society of Anesthesiology and Intensive Care Medicine (DGAI), the Professional Association of German Anesthesiologists (BDA), the European Society of Anesthesiology and Intensive Care Medicine (ESAIC), the Scientific Working Group for Pediatric Anesthesia and since 2021, Speaker of the Scientific Working Group for Pediatric Cardiac Anesthesia of the German Society of Anesthesiology. Her focus is on the research of pediatric anesthesia. She coordinated a national study on preoperative fasting in children for the Scientific Working Group for Pediatric Anesthesia and is part of the research group of Prof. Robert Sümpelmann. She has published several journal articles and book chapters, mainly on the field of pediatric anesthesia. She is a passionate mentor for trainees and early career junior residence in building a clinical or scientific career. Dr Christiane Beck has been involved on a voluntary basis as the leading anesthetist to pediatric cardiac missions to Moldova, Bosnia Herzegovina, Cyprus and Romania. She is in close contact and provides support to an innovative project MOHKI – the mobile kinderherzen clinic of kinderherzen - Fördergemeinschaft deutscher Kinderherzzentren e.V. to provide excellent medical infrastructure for cardiac missions in low-income countries. Wolfgang BuhreWolfgang BuhreWolfgang Buhre is Anaesthesiologist and Medical Director of the Division of Anesthesiology, Perioperative Medicine, Emergency Medicine and Critical Care Medicine at Maastricht University Medical Centre (MumC), The Netherlands. He is also Professor of Anesthesiology at Maastricht University, The Netherlands. At Maastricht, he is a member of the School Council and a research fellow in the School of Mental Health and Neurosciences (MhenS). He is also an associated research fellow in the Care and Public health Research Institute (CAPHRI), Maastricht University. He earned his medical degree at the University of Göttingen, Germany, where he also completed his residency training. He is trained in intensive care medicine and pain medicine. His areas of research are outcome research, artificial intelligence, and modern technology to support decision making in clinical practice. Wolfgang Buhre is leading the Research Mentorship Program of the European Society of Anaesthesiology and Intensive Care Medicine (ESAIC). Moreover, he is coordinating investigator in the Academic Research Organization of ESAIC and serves within the society also as industrial liaison member for the Academic Research Organization (A-CRO).

Selected 2021 Highlights in Congenital Cardiac Anesthesia

This article is a review of the highlights of pertinent literature of interest to the congenital cardiac anesthesiologist and was published in 2021. After a search of the United States National Library of Medicine PubMed database, several topics emerged where significant contributions were made in 2021. The authors of this manuscript considered the following topics noteworthy to be included in this review: risk stratification in adult congenital heart disease surgery, physician burnout in pediatric cardiac anesthesia, transfusion practice in pediatric congenital heart surgery, and racial disparity and outcomes in pediatric patients with congenital heart disease.

Efficacy of bilateral PECS II block in postoperative analgesia for ultrafast track pediatric cardiac anesthesia

ABSTRACT Background Effective analgesia after cardiac surgery contributes to fast recovery, and discharge from the critical care unit. Aim: This study was conducted to evaluate PECS II block for controlling post-sternotomy pain in pediatric population in ultrafast track cardiac surgery. Methods In this double-blind, randomized control trial, 40 children, 1–5 years old, underwent cardiac surgery via median sternotomy, Group (A) control: Analgesics were administered intravenously. Group (B): received 0.25% bupivacaine at 0.5 ml/kg divided equally to both sides for PECS block. Results PECS group had lower median Modified Objective Pain Score (MOPS) immediately, two, four, and 6 h postoperatively. PECS group had lower median fentanyl utilization by 35% than the control group with median utilization of 2.72 (95% CI 2.490–2.960) mic/kg/in the first 24 hours in contrast to 4.17 (95% CI 3.834–4.516) mic/kg/in the first 24 hours in the control group (P < 0.001). First rescue analgesia was later in PECS group compared to the control group with median time (7 hours) and (2 hours), respectively. Furthermore, Pediatric Anesthesia Emergence Agitation (PAED) score was lower in the intervention group with median 9.5 and 12 in the control group (P < 0.001). PECS group had shorter ICU stay than the control group (P < 0.05), with mean ICU stay 52 hours (95% CI 43.522–62.378) compared to 80.40 hours (95% CI 64.310–96.490). Conclusion PECS block is an efficient technique that can be implemented as an integral part of fast-track cardiac surgery.

The Practice of Pediatric Cardiac Anesthesiology in the United States.

With advances in surgical and catheter-based interventions and technologies in patients with congenital heart disease (CHD), the practice of pediatric cardiac anesthesiology has evolved in parallel with pediatric cardiac surgery and pediatric cardiology as a distinct subspecialty over the past 80 years. To date, there has not been an analysis of the distribution of pediatric cardiac anesthesiologists relative to cardiac and noncardiac procedures in the pediatric population. The primary aim is to report the results of a survey and its subsequent analysis to describe the distribution of pediatric cardiac anesthesiologists relative to pediatric cardiac procedures that include surgical interventions, cardiac catheterization procedures, imaging studies (echocardiography, magnetic resonance, computed tomography, positron emission tomography), and noncardiac procedures. A survey developed in Research Electronic Data Capture (REDcap) was sent to the identifiable division chiefs/cardiac directors of 113 pediatric cardiac anesthesia programs in the United States. Data regarding cardiac surgical patients and procedures were collected from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHD). This analysis reveals that only 38% (117 of 307) of pediatric cardiac anesthesiologists caring for patients with CHD pursued additional training in pediatric cardiac anesthesiology, while 44% (136 of 307) have gained experience during their clinical practice. Other providers have pursued different training pathways such as adult cardiac anesthesiology or pediatric critical care. Based on this survey, pediatric cardiac anesthesiologists devote 35% (interquartile range [IQR], 20%-50%) of clinical time to the care of patients in the cardiac operating room, 25% (20%-35%) of time to the care of patients in the cardiac catheterization laboratory, 10% (5%-10%) to patient care in imaging locations, and 15% covering general pediatric, adult, or cardiac patients undergoing noncardiac procedures. Attempts to actively recruit pediatric cardiac anesthesiologists were reported by 49.2% (29 of 59) of the institutions surveyed. Impending retirement of staff was anticipated in 17% (10 of 59) of the institutions, while loss of staff to relocation was anticipated in 3.4% (2 of 59) of institutions. Thirty-seven percent of institutions reported that they anticipated no immediate changes in current staffing levels. The majority of currently practicing pediatric cardiac anesthesiologists have not completed a fellowship training in the subspecialty. There is, and will continue to be, a need for subspecialty training to meet increasing demand for services especially with increase survival of this patient population and to replace retiring members of the workforce.

Congenital Cardiac Anesthesia: A Case-based Approach

Congenital Cardiac Anesthesia: A Case-based Approach

Paediatric cardiac anaesthesia perspective in komfo anokye teaching hospital kumasi: A 10-year review

Background: Infant mortality due to congenital malformations has an incident rate of 8 cases per 1000 live births. Due to Africa's inadequate health-care systems, congenital cardiac disease (CCD) remains a paediatric health-care issue. CCD patients undergo an open-heart operation (OHO) at the Komfo Anokye Teaching Hospital (KATH) in Kumasi. Aim: This study aimed to compare trends of cardiac anaesthesia protocols before and after 2014 and to assess the efficiency and quality of surgical care provided to children with CCD following the implementation of new cardiac anaesthesia protocols in 2014. Materials and Methods: Groups A and B were represented by the years before and after 2014. This was a retrospective study involving 118 patients who underwent OHO under general anaesthesia from 2007 to 2016 after obtaining Institutional ethical approval. Results: In Groups A and B, the mean length of hospitalization in days and cardiac care unit stay in days were (6.87 ± 3.51 and 4.20 ± 3.66) (P = 0.046) and (3.14 ± 2.37 and 1.96 ± 2.85) (P = 0.382), respectively. In Group B, ultrafast track extubations increased from 7.25% to 39.71% (P = 0.021), while patients mean mechanically ventilation time decreased by 82.34 ± 11.70–23.48 ± 7.94 h (P = 0.018). In the first 48 h, the chest tube's postoperative drainage reduced by 133 ± 28.46–95 ± 20.38 ml (P = 0.018) and haemorrhage leading to re-exploration decreased 11.77%–1.50% (P = 0.019). After 2014, postoperative haemorrhage, the chest tube's drainage, and re-exploration were statistically significantly reduced by tranexamic acid. Conclusions: This ten-year program primarily focused on selecting simple cases and simplifying anaesthesia protocols after 2014. Given the success of our OHO program at KATH Kumasi, there is a need for a paradigm shift to sustain OHO programs in other parts of Africa.

The last 50 years of pediatric cardiology (1971-2021): from Fontan operation to the present time

Pediatric cardiology has matured profoundly over the last 50 years, paralleled by a similar development in pediatric cardiac surgery and cardiac anesthesia. This field of medicine provides structured and effective care for a very heterogeneous group of diseases including congenital heart disease, cardiomyopathies and heart failure, myocarditis, rheumatic heart disease, inherited and acquired arrhythmias, Kawasaki disease and more recently multisystemic inflammatory syndrome of children related to primary infection by SARS-CoV-2. This review summarizes achievements and results in selected topics of pediatric cardiology and cardiac surgery with focused attention to the diagnosis and management of congenital heart diseases.

European Association of Cardiothoracic Anesthesiology and Intensive Care Pediatric Cardiac Anesthesia Fellowship Curriculum: First Edition

Pediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretical and practical requirements for fellows and host centers.

Research in pediatric cardiac anesthesia and intensive care in low- and middle- income countries and low resource settings: Challenges and opportunities.

Research in pediatric cardiac anesthesia and intensive care in low- and middle- income countries and low resource settings: Challenges and opportunities.

Current Trends in Pediatric Cardiac Anesthesia

Current Trends in Pediatric Cardiac Anesthesia