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Paediatric cardiac catheterization: innovations

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Abstract

In recent years interventional procedures have been introduced to the field of paediatric cardiac catheterization. These procedures continue to develop in complexity and increasingly are being applied to patients with reduced cardiovascular reserve, as an alternative to cardiac surgery or when cardiac surgery with cardiopulmonary bypass is contraindicated. More frequently anaesthetists are being called upon to provide support in sedating, anaesthetizing or/and resuscitating these patients. The purpose of this review is to give a comprehensive update of the interventional procedures and to review the anaesthetic management techniques as they apply to the catheterization laboratory. We will discuss possible complications and management strategies from our own experience and the experience of others. We have observed that as more complicated procedures are performed the anaesthetist plays a pivotal role in the management of the patient from arrival to departure from the cardiac catheterization laboratory, and in preventing mortality and major morbidity. Although the economic consequences of interventional cardiological techniques remain unclear, the field continues to expand and more complex procedures are continually being introduced.

Résumé

Depuis peu, on realise chez l’enfant des interventions par cathétérisme cardiaque. Ces interventions sont de plus en plus complexes et sont pratiquées sur des patients dont les réserves cardiaques sont diminuées, à la place de la chirurgie ou lorsque la circulation extracorporelle est contre-indiquée. On fait de plus en plus appel aux anesthésistes pour procurer à ces patients la sédation, l’anesthésie et la réanimation. Ce survol a pour but de faire le point sur ces interventions et de passer en revue les techniques de gestion anesthésique telles qu’elles s’appliquent à un laboratoire de cathétérisme cardiaque. Nous examinerons les complications possibles et les stratégies de gestion à partir de notre expérience et de celle des autres. Nous avons observé que lorsqu’il s’agit de prévenir la morbidité et la mortalité, le rôle central de l’anesthésiste s’accroît proportionnellement à la complexité de l’intervention et depuis l’arrivée du patient en salle de cathétérisme jusqu’à son départ. Bien que les conséquences économiques de ce type d’intervention soient encore mal connues, ce champ d’activité est en pleine expansion et des techniques encore plus complexes font régulièrement leur apparition.

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Correspondence to Joseph J. Javorski or Frederick A. Burrows.

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Javorski, J.J., Hansen, D.D., Laussen, P.C. et al. Paediatric cardiac catheterization: innovations. Can J Anaesth 42, 310–329 (1995). https://doi.org/10.1007/BF03010708

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Key words

  • anaesthesia: paediatric, cardiac
  • heart: catheterization, complications