Anesthetic management of pediatric cardiac transplantation

Richard Lee Applegate, Linda J. Mason, Teresa L. Thompson

Research output: Contribution to journalReview article

Abstract

Cardiac transplantation has become a widely accepted therapy for a variety of end-stage cardiac diseases in pediatric patients. From November 1985 to November 1999, 347 pediatric cardiac transplantations were performed at Loma Linda University Medical Center (LLUMC), including 235 in children younger than 6 months of age. It is essential to be familiar with the physiologic and anatomic characteristics of the recipient. Hypoplastic left heart syndrome is the most frequent congenital disorder leading to transplant in neonates at LLUMC, with diseases presenting with left ventricular failure accounting for the majority of the remainder of patients. We have assessed many variables for a possible relationship to intraoperative or postoperative complications, including anesthetic induction and maintenance agents, pH and base excess, as determined by arterial blood gas analysis before cardiopulmonary bypass (CPB), and hemodynamic changes requiring treatment before CPB. Although we have noticed an association between low patient temperature or mechanical stimulation at the time of sternotomy, and hemodynamic complications before CPB, in our experience no single anesthetic technique or intraoperative event, including ventricular fibrillation, predicts early mortality. We believe anesthetic management of pediatric cardiac transplant recipients should be tailored to fit the pathophysiology present.

Original languageEnglish (US)
Pages (from-to)55-61
Number of pages7
JournalSeminars in Cardiothoracic and Vascular Anesthesia
Volume5
Issue number1
DOIs
StatePublished - 2001
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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