RESUMO
This review highlights published literature in 2023 that is related to the anesthetic management of patients with congenital heart disease (CHD). Though not inclusive of all topics, 31 articles are discussed and four primary themes emerged: transfusion and hemostasis, outcomes and risk assessment, monitoring, and pharmacology.
Assuntos
Anestesia , Cardiopatias Congênitas , Humanos , Cardiopatias Congênitas/cirurgia , Anestesia/métodos , Transfusão de Sangue/métodos , Medição de Risco , Anestesia em Procedimentos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/métodosRESUMO
Shone's complex is a congenital cardiac disease consisting of the following four lesions: parachute mitral valve, supravalvar mitral ring, subaortic stenosis, and aortic coarctation. Though not all components are required for a diagnosis, the end result is both left ventricular inflow and outflow obstruction, which typically present in patients as congestive heart failure. The complex pathology requires careful management and surgical decision-making to ensure an optimal outcome. This review will focus on the anatomy, physiology, and perioperative anesthetic management of patients with Shone's complex.
Assuntos
Anestésicos , Coartação Aórtica , Cardiopatias Congênitas , Estenose da Valva Mitral , Humanos , Estenose da Valva Mitral/cirurgia , Cardiopatias Congênitas/cirurgia , Cardiopatias Congênitas/diagnóstico , Coartação Aórtica/cirurgia , Valva Mitral/cirurgia , Valva Mitral/patologiaRESUMO
This review focuses on the literature published during the calendar year 2022 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease (CHD). Four major themes are discussed: enhanced recovery after surgery(ERAS); diversity, equity, and inclusion; the state of pediatric cardiac anesthesiology as a subspecialty in the United States; and neuromonitoring for pediatric cardiac surgery.
Assuntos
Anestesia , Anestesiologia , Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Adulto , Humanos , Criança , Cardiopatias Congênitas/cirurgia , CoraçãoRESUMO
This review focuses on the literature published during the calendar year 2021 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Four major themes are discussed, including cardiovascular disease in children with COVID-19, aortic valve repair and replacement, bleeding and coagulation, and enhanced recovery after surgery (ERAS).
Assuntos
Anestesia , Anestesiologia , COVID-19 , Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Adulto , Criança , Cardiopatias Congênitas/cirurgia , HumanosRESUMO
This review focuses on the literature published during the calendar year 2020 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five major themes are discussed, including COVID-19 in children with heart disease, race and outcome disparities in congenital heart disease, Norwood procedure and outcomes, Fontan procedure and outcomes, and neurotoxicity/neurologic outcomes. A total of 59 peer-reviewed articles are discussed.
Assuntos
Anestesia/métodos , COVID-19/complicações , Cardiopatias Congênitas/cirurgia , Adulto , COVID-19/fisiopatologia , Criança , Técnica de Fontan , Disparidades nos Níveis de Saúde , Cardiopatias Congênitas/epidemiologia , Humanos , Procedimentos de NorwoodAssuntos
Anafilaxia/induzido quimicamente , Anestesia Geral/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Midazolam/efeitos adversos , Adolescente , Anafilaxia/diagnóstico , Anafilaxia/terapia , Cloreto de Cálcio/uso terapêutico , Reanimação Cardiopulmonar , Ablação por Cateter/efeitos adversos , Epinefrina/uso terapêutico , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Midazolam/administração & dosagem , Monitorização Intraoperatória , Síndrome de Wolff-Parkinson-White/cirurgiaRESUMO
BACKGROUND: Adaptive optics scanning light ophthalmoscopy (AOSLO) enables direct visualisation of the cone mosaic, with metrics such as cone density and cell spacing used to assess the integrity or health of the mosaic. Here we examined the interobserver and inter-instrument reliability of cone density measurements. METHODS: For the interobserver reliability study, 30 subjects with no vision-limiting pathology were imaged. Three image sequences were acquired at a single parafoveal location and aligned to ensure that the three images were from the same retinal location. Ten observers used a semiautomated algorithm to identify the cones in each image, and this was repeated three times for each image. To assess inter-instrument reliability, 20 subjects were imaged at eight parafoveal locations on one AOSLO, followed by the same set of locations on the second AOSLO. A single observer manually aligned the pairs of images and used the semiautomated algorithm to identify the cones in each image. RESULTS: Based on a factorial study design model and a variance components model, the interobserver study's largest contribution to variability was the subject (95.72%) while the observer's contribution was only 1.03%. For the inter-instrument study, an average cone density intraclass correlation coefficient (ICC) of between 0.931 and 0.975 was calculated. CONCLUSIONS: With the AOSLOs used here, reliable cone density measurements can be obtained between observers and between instruments. Additional work is needed to determine how these results vary with differences in image quality.
