Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events
Summary Background Patients with single ventricle physiology are at increased anesthetic risk when undergoing noncardiac surgery. Objective To review the outcomes of anesthetics for patients with single ventricle physiology undergoing noncardiac surgery. Methods This study is a retrospective chart r...
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| Veröffentlicht in: | Pediatric anesthesia 2015-08, Vol.25 (8), p.846-851 |
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| creator | Brown, Morgan L. DiNardo, James A. Odegard, Kirsten C. |
| description | Summary
Background
Patients with single ventricle physiology are at increased anesthetic risk when undergoing noncardiac surgery.
Objective
To review the outcomes of anesthetics for patients with single ventricle physiology undergoing noncardiac surgery.
Methods
This study is a retrospective chart review of all patients who underwent a palliative procedure for single ventricle physiology between January 1, 2007 and January 31, 2014. Anesthetic and surgical records were reviewed for noncardiac operations that required sedation or general anesthesia. Any noncardiac operation occurring prior to completion of a bidirectional Glenn procedure was included. Diagnostic procedures, including cardiac catheterization, insertion of permanent pacemaker, and procedures performed in the ICU, were excluded.
Results
During the review period, 417 patients with single ventricle physiology had initial palliation. Of these, 70 patients (16.7%) underwent 102 anesthetics for 121 noncardiac procedures. The noncardiac procedures included line insertion (n = 23); minor surgical procedures such as percutaneous endoscopic gastrostomy or airway surgery (n = 38); or major surgical procedures including intra‐abdominal and thoracic operations (n = 41). These interventions occurred on median day 60 of life (1–233 days). The procedures occurred most commonly in the operating room (n = 79, 77.5%). Patients’ median weight was 3.4 kg (2.4–15 kg) at time of noncardiac intervention. In 102 anesthetics, 26 patients had an endotracheal tube or tracheostomy in situ, 57 patients underwent endotracheal intubation, and 19 patients had a natural or mask airway. An intravenous induction was performed in 77 anesthetics, an inhalational induction in 17, and a combination technique in 8. The median total anesthetic time was 126 min (14–594 min). In 22 anesthetics (21.6%), patients were on inotropic support upon arrival; an additional 24 patients required inotropic support (23.5%), of which dopamine was the most common medication. There were 10 intraoperative adverse events (9.8%) including: arrhythmias requiring treatment (n = 4), conversion from sedation to a general anesthetic (n = 2), difficult airway (n = 1), inadvertent extubation with desaturation and bradycardia (n = 1), hypotension and desaturation (n = 1), and cardiac arrest (n = 1). Postoperative events ( |
| doi_str_mv | 10.1111/pan.12685 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1694963187</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3735683811</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4615-ae337e6fa95ff3b21bfb34516df685b7fb91dc8f0f24847649b6c5c2106f6fd23</originalsourceid><addsrcrecordid>eNp1kU1P3DAQhq0KBJRy6B-oLHEph4A_Ymd9pJQvQSmVWvVoOc44azYbb-0Emn-PYYFDpfri0eiZR_a8CH2k5JDmc7Qy_SFlcibeoR1aSlIoodhGrqkQhZCl2EbvU7ojhHIm2RbaZkJVhHG2gxa3ZvDQDwk_-GGOk-_bDvB97kRvc7WaT8mHLrQTHvsGYhsygfvQWxMbbyxOY2whTthEwGbAc9_OcfRpgV2I2DT3EBNgeBKmD2jTmS7B3su9i36dnf48uSiuv59fnhxfF7aUVBQGOK9AOqOEc7xmtHY1LwWVjctfrCtXK9rYmSOOlbOykqWqpRWWUSKddA3ju-jz2ruK4c8IadBLnyx0nekhjElTqUolOZ1VGd3_B70LY-zz654pohSrRKYO1pSNIaUITq-iX5o4aUr0UwI6J6CfE8jspxfjWC-heSNfV56BozXw4DuY_m_St8c3r8piPeHTAH_fJkxcaFnxSujfN-f67MvFj6uv5JsW_BF5EaAr</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1694099275</pqid></control><display><type>article</type><title>Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Brown, Morgan L. ; DiNardo, James A. ; Odegard, Kirsten C.</creator><contributor>Hammer, Greg ; Hammer, Greg</contributor><creatorcontrib>Brown, Morgan L. ; DiNardo, James A. ; Odegard, Kirsten C. ; Hammer, Greg ; Hammer, Greg</creatorcontrib><description>Summary
Background
Patients with single ventricle physiology are at increased anesthetic risk when undergoing noncardiac surgery.
Objective
To review the outcomes of anesthetics for patients with single ventricle physiology undergoing noncardiac surgery.
Methods
This study is a retrospective chart review of all patients who underwent a palliative procedure for single ventricle physiology between January 1, 2007 and January 31, 2014. Anesthetic and surgical records were reviewed for noncardiac operations that required sedation or general anesthesia. Any noncardiac operation occurring prior to completion of a bidirectional Glenn procedure was included. Diagnostic procedures, including cardiac catheterization, insertion of permanent pacemaker, and procedures performed in the ICU, were excluded.
Results
During the review period, 417 patients with single ventricle physiology had initial palliation. Of these, 70 patients (16.7%) underwent 102 anesthetics for 121 noncardiac procedures. The noncardiac procedures included line insertion (n = 23); minor surgical procedures such as percutaneous endoscopic gastrostomy or airway surgery (n = 38); or major surgical procedures including intra‐abdominal and thoracic operations (n = 41). These interventions occurred on median day 60 of life (1–233 days). The procedures occurred most commonly in the operating room (n = 79, 77.5%). Patients’ median weight was 3.4 kg (2.4–15 kg) at time of noncardiac intervention. In 102 anesthetics, 26 patients had an endotracheal tube or tracheostomy in situ, 57 patients underwent endotracheal intubation, and 19 patients had a natural or mask airway. An intravenous induction was performed in 77 anesthetics, an inhalational induction in 17, and a combination technique in 8. The median total anesthetic time was 126 min (14–594 min). In 22 anesthetics (21.6%), patients were on inotropic support upon arrival; an additional 24 patients required inotropic support (23.5%), of which dopamine was the most common medication. There were 10 intraoperative adverse events (9.8%) including: arrhythmias requiring treatment (n = 4), conversion from sedation to a general anesthetic (n = 2), difficult airway (n = 1), inadvertent extubation with desaturation and bradycardia (n = 1), hypotension and desaturation (n = 1), and cardiac arrest (n = 1). Postoperative events (<48 h) included ST segment changes requiring cardiac catheterization (n = 1), and cardiorespiratory arrest (n = 1). Age, size, gender, type of cardiac palliation, patient location, procedure location, and type of procedure were not associated with adverse outcome. After 62 anesthetics (60.8%), patients went postoperatively to the cardiac ICU. There were no deaths at 48 h.
Conclusion
We observed no mortality during or after noncardiac surgery in a high‐risk subgroup of palliated cardiac patients with single ventricle physiology. However, 11.8% of patients had an adverse event associated with their anesthetic.</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1111/pan.12685</identifier><identifier>PMID: 25970232</identifier><language>eng</language><publisher>France: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; anesthesia ; Anesthesia - adverse effects ; Comorbidity ; congenital ; Female ; Fontan Procedure ; heart defects ; Heart Defects, Congenital - epidemiology ; Heart Ventricles - abnormalities ; Humans ; Incidence ; intraoperative complications ; Intraoperative Complications - epidemiology ; Male ; Middle Aged ; Norwood procedures ; operative ; Palliative Care - methods ; postoperative complications ; Postoperative Complications - epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; surgical procedure ; Surgical Procedures, Operative - statistics & numerical data</subject><ispartof>Pediatric anesthesia, 2015-08, Vol.25 (8), p.846-851</ispartof><rights>2015 John Wiley & Sons Ltd</rights><rights>2015 John Wiley & Sons Ltd.</rights><rights>Copyright © 2015 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4615-ae337e6fa95ff3b21bfb34516df685b7fb91dc8f0f24847649b6c5c2106f6fd23</citedby><cites>FETCH-LOGICAL-c4615-ae337e6fa95ff3b21bfb34516df685b7fb91dc8f0f24847649b6c5c2106f6fd23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpan.12685$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpan.12685$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25970232$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Hammer, Greg</contributor><contributor>Hammer, Greg</contributor><creatorcontrib>Brown, Morgan L.</creatorcontrib><creatorcontrib>DiNardo, James A.</creatorcontrib><creatorcontrib>Odegard, Kirsten C.</creatorcontrib><title>Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events</title><title>Pediatric anesthesia</title><addtitle>Paediatr Anaesth</addtitle><description>Summary
Background
Patients with single ventricle physiology are at increased anesthetic risk when undergoing noncardiac surgery.
Objective
To review the outcomes of anesthetics for patients with single ventricle physiology undergoing noncardiac surgery.
Methods
This study is a retrospective chart review of all patients who underwent a palliative procedure for single ventricle physiology between January 1, 2007 and January 31, 2014. Anesthetic and surgical records were reviewed for noncardiac operations that required sedation or general anesthesia. Any noncardiac operation occurring prior to completion of a bidirectional Glenn procedure was included. Diagnostic procedures, including cardiac catheterization, insertion of permanent pacemaker, and procedures performed in the ICU, were excluded.
Results
During the review period, 417 patients with single ventricle physiology had initial palliation. Of these, 70 patients (16.7%) underwent 102 anesthetics for 121 noncardiac procedures. The noncardiac procedures included line insertion (n = 23); minor surgical procedures such as percutaneous endoscopic gastrostomy or airway surgery (n = 38); or major surgical procedures including intra‐abdominal and thoracic operations (n = 41). These interventions occurred on median day 60 of life (1–233 days). The procedures occurred most commonly in the operating room (n = 79, 77.5%). Patients’ median weight was 3.4 kg (2.4–15 kg) at time of noncardiac intervention. In 102 anesthetics, 26 patients had an endotracheal tube or tracheostomy in situ, 57 patients underwent endotracheal intubation, and 19 patients had a natural or mask airway. An intravenous induction was performed in 77 anesthetics, an inhalational induction in 17, and a combination technique in 8. The median total anesthetic time was 126 min (14–594 min). In 22 anesthetics (21.6%), patients were on inotropic support upon arrival; an additional 24 patients required inotropic support (23.5%), of which dopamine was the most common medication. There were 10 intraoperative adverse events (9.8%) including: arrhythmias requiring treatment (n = 4), conversion from sedation to a general anesthetic (n = 2), difficult airway (n = 1), inadvertent extubation with desaturation and bradycardia (n = 1), hypotension and desaturation (n = 1), and cardiac arrest (n = 1). Postoperative events (<48 h) included ST segment changes requiring cardiac catheterization (n = 1), and cardiorespiratory arrest (n = 1). Age, size, gender, type of cardiac palliation, patient location, procedure location, and type of procedure were not associated with adverse outcome. After 62 anesthetics (60.8%), patients went postoperatively to the cardiac ICU. There were no deaths at 48 h.
Conclusion
We observed no mortality during or after noncardiac surgery in a high‐risk subgroup of palliated cardiac patients with single ventricle physiology. However, 11.8% of patients had an adverse event associated with their anesthetic.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>anesthesia</subject><subject>Anesthesia - adverse effects</subject><subject>Comorbidity</subject><subject>congenital</subject><subject>Female</subject><subject>Fontan Procedure</subject><subject>heart defects</subject><subject>Heart Defects, Congenital - epidemiology</subject><subject>Heart Ventricles - abnormalities</subject><subject>Humans</subject><subject>Incidence</subject><subject>intraoperative complications</subject><subject>Intraoperative Complications - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Norwood procedures</subject><subject>operative</subject><subject>Palliative Care - methods</subject><subject>postoperative complications</subject><subject>Postoperative Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>surgical procedure</subject><subject>Surgical Procedures, Operative - statistics & numerical data</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1P3DAQhq0KBJRy6B-oLHEph4A_Ymd9pJQvQSmVWvVoOc44azYbb-0Emn-PYYFDpfri0eiZR_a8CH2k5JDmc7Qy_SFlcibeoR1aSlIoodhGrqkQhZCl2EbvU7ojhHIm2RbaZkJVhHG2gxa3ZvDQDwk_-GGOk-_bDvB97kRvc7WaT8mHLrQTHvsGYhsygfvQWxMbbyxOY2whTthEwGbAc9_OcfRpgV2I2DT3EBNgeBKmD2jTmS7B3su9i36dnf48uSiuv59fnhxfF7aUVBQGOK9AOqOEc7xmtHY1LwWVjctfrCtXK9rYmSOOlbOykqWqpRWWUSKddA3ju-jz2ruK4c8IadBLnyx0nekhjElTqUolOZ1VGd3_B70LY-zz654pohSrRKYO1pSNIaUITq-iX5o4aUr0UwI6J6CfE8jspxfjWC-heSNfV56BozXw4DuY_m_St8c3r8piPeHTAH_fJkxcaFnxSujfN-f67MvFj6uv5JsW_BF5EaAr</recordid><startdate>201508</startdate><enddate>201508</enddate><creator>Brown, Morgan L.</creator><creator>DiNardo, James A.</creator><creator>Odegard, Kirsten C.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201508</creationdate><title>Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events</title><author>Brown, Morgan L. ; DiNardo, James A. ; Odegard, Kirsten C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4615-ae337e6fa95ff3b21bfb34516df685b7fb91dc8f0f24847649b6c5c2106f6fd23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>anesthesia</topic><topic>Anesthesia - adverse effects</topic><topic>Comorbidity</topic><topic>congenital</topic><topic>Female</topic><topic>Fontan Procedure</topic><topic>heart defects</topic><topic>Heart Defects, Congenital - epidemiology</topic><topic>Heart Ventricles - abnormalities</topic><topic>Humans</topic><topic>Incidence</topic><topic>intraoperative complications</topic><topic>Intraoperative Complications - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Norwood procedures</topic><topic>operative</topic><topic>Palliative Care - methods</topic><topic>postoperative complications</topic><topic>Postoperative Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>surgical procedure</topic><topic>Surgical Procedures, Operative - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brown, Morgan L.</creatorcontrib><creatorcontrib>DiNardo, James A.</creatorcontrib><creatorcontrib>Odegard, Kirsten C.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brown, Morgan L.</au><au>DiNardo, James A.</au><au>Odegard, Kirsten C.</au><au>Hammer, Greg</au><au>Hammer, Greg</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events</atitle><jtitle>Pediatric anesthesia</jtitle><addtitle>Paediatr Anaesth</addtitle><date>2015-08</date><risdate>2015</risdate><volume>25</volume><issue>8</issue><spage>846</spage><epage>851</epage><pages>846-851</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><abstract>Summary
Background
Patients with single ventricle physiology are at increased anesthetic risk when undergoing noncardiac surgery.
Objective
To review the outcomes of anesthetics for patients with single ventricle physiology undergoing noncardiac surgery.
Methods
This study is a retrospective chart review of all patients who underwent a palliative procedure for single ventricle physiology between January 1, 2007 and January 31, 2014. Anesthetic and surgical records were reviewed for noncardiac operations that required sedation or general anesthesia. Any noncardiac operation occurring prior to completion of a bidirectional Glenn procedure was included. Diagnostic procedures, including cardiac catheterization, insertion of permanent pacemaker, and procedures performed in the ICU, were excluded.
Results
During the review period, 417 patients with single ventricle physiology had initial palliation. Of these, 70 patients (16.7%) underwent 102 anesthetics for 121 noncardiac procedures. The noncardiac procedures included line insertion (n = 23); minor surgical procedures such as percutaneous endoscopic gastrostomy or airway surgery (n = 38); or major surgical procedures including intra‐abdominal and thoracic operations (n = 41). These interventions occurred on median day 60 of life (1–233 days). The procedures occurred most commonly in the operating room (n = 79, 77.5%). Patients’ median weight was 3.4 kg (2.4–15 kg) at time of noncardiac intervention. In 102 anesthetics, 26 patients had an endotracheal tube or tracheostomy in situ, 57 patients underwent endotracheal intubation, and 19 patients had a natural or mask airway. An intravenous induction was performed in 77 anesthetics, an inhalational induction in 17, and a combination technique in 8. The median total anesthetic time was 126 min (14–594 min). In 22 anesthetics (21.6%), patients were on inotropic support upon arrival; an additional 24 patients required inotropic support (23.5%), of which dopamine was the most common medication. There were 10 intraoperative adverse events (9.8%) including: arrhythmias requiring treatment (n = 4), conversion from sedation to a general anesthetic (n = 2), difficult airway (n = 1), inadvertent extubation with desaturation and bradycardia (n = 1), hypotension and desaturation (n = 1), and cardiac arrest (n = 1). Postoperative events (<48 h) included ST segment changes requiring cardiac catheterization (n = 1), and cardiorespiratory arrest (n = 1). Age, size, gender, type of cardiac palliation, patient location, procedure location, and type of procedure were not associated with adverse outcome. After 62 anesthetics (60.8%), patients went postoperatively to the cardiac ICU. There were no deaths at 48 h.
Conclusion
We observed no mortality during or after noncardiac surgery in a high‐risk subgroup of palliated cardiac patients with single ventricle physiology. However, 11.8% of patients had an adverse event associated with their anesthetic.</abstract><cop>France</cop><pub>Blackwell Publishing Ltd</pub><pmid>25970232</pmid><doi>10.1111/pan.12685</doi><tpages>6</tpages></addata></record> |
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| ispartof | Pediatric anesthesia, 2015-08, Vol.25 (8), p.846-851 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Aged, 80 and over anesthesia Anesthesia - adverse effects Comorbidity congenital Female Fontan Procedure heart defects Heart Defects, Congenital - epidemiology Heart Ventricles - abnormalities Humans Incidence intraoperative complications Intraoperative Complications - epidemiology Male Middle Aged Norwood procedures operative Palliative Care - methods postoperative complications Postoperative Complications - epidemiology Retrospective Studies Risk Assessment Risk Factors surgical procedure Surgical Procedures, Operative - statistics & numerical data |
| title | Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events |
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