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J Pediatr Intensive Care
DOI: 10.1055/s-0043-1762909
Review Article

Procedural Sedation in Congenital Heart Disease

Saadeh Al-Jureidini
1   Division of Cardiology, Department of Pediatrics, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St. Louis, Missouri, United States
,
Shadi Al-Jureidini 
2   Department of Pharmacy, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri, United States
,
Reema Patel
3   American Board of Pediatrics and Subboard of Pediatric Cardiology, John Hopkins All Children's Hospital, St. Petersburg, Florida, United States
,
Renuka Peterson
1   Division of Cardiology, Department of Pediatrics, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St. Louis, Missouri, United States
,
Michael Czajka
4   Division of Cardiology, Department of Pediatrics, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri, United States
,
Andrew Fiore
5   Division of Cardiothoracic Surgery, Department of Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St. Louis, Missouri, United States
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Abstract

Procedural sedation in patients with congenital heart disease (CHD) is associated with significant morbidity and mortality. It is vital for the practitioner to fully understand the complexity of lesions, their hemodynamics, and the impact of medications commonly used for procedural sedation on the stability of systemic vascular resistance and pulmonary flow. According to the literature, we explain the interaction of the systemic vascular resistance and pulmonary flow in such lesions and divide them into five categories outlined in this article: (1) CHDs with left-to-right shunt with normal pulmonary arterial pressure and resistance, (2) CHD with left-to-right shunt and moderate to severe elevation of pulmonary arterial pressure with near-normal pulmonary vascular resistance, (3) CHD with pulmonary flow dependent on systemic vascular resistance, (4) patients with congenital coronary stenosis and coronary anomalies, and 5) aortic obstructive lesions.

Keywords

procedural sedation - congenital heart disease - systemic vascular resistance - pulmonary vascular resistance - surgical shunts


Publication History

Received: 02 November 2022

Accepted: 09 January 2023

Article published online:
24 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Diaz LK, Jones L. Sedating the child with congenital heart disease. Anesthesiol Clin 2009; 27 (02) 301-319
    CrossrefPubMedSearch in Google Scholar
  • 2 Kaye AD, Stout TB, Padnos IW. et al. Left-to-right cardiac shunt: perioperative anesthetic considerations. Middle East J Anaesthesiol 2012; 21 (06) 793-806
    PubMedSearch in Google Scholar
  • 3 Krongrad E, Helmholz Jr HF, Ritter DG. Effect of breathing oxygen in patients with severe pulmonary vascular obstructive disease. Circulation 1973; 47 (01) 94-100
    CrossrefPubMedSearch in Google Scholar
  • 4 Packer M, Lee WH, Medina N, Yushak M. Systemic vasoconstrictor effects of oxygen administration in obliterative pulmonary vascular disorders. Am J Cardiol 1986; 57 (10) 853-858
    CrossrefPubMedSearch in Google Scholar
  • 5 Greeley WJ, Stanley III TE, Ungerleider RM, Kisslo JA. Intraoperative hypoxemic spells in tetralogy of Fallot. An echocardiographic analysis of diagnosis and treatment. Anesth Analg 1989; 68 (06) 815-819
    CrossrefPubMedSearch in Google Scholar
  • 6 Charms BL, Brofman BL, Kohn PM. Pulmonary resistance in acquired heart disease. Circulation 1959; 20: 850-855
    CrossrefPubMedSearch in Google Scholar
  • 7 Kottenberg-Assenmacher E, Aleksic I, Eckholt M, Lehmann N, Peters J. Critical closing pressure as the arterial downstream pressure with the heart beating and during circulatory arrest. Anesthesiology 2009; 110 (02) 370-379
    CrossrefPubMedSearch in Google Scholar
  • 8 Johnson PN, Miller JL, Hagemann TM. Sedation and analgesia in critically ill children. AACN Adv Crit Care 2012; 23 (04) 415-434 , quiz 435–436
    CrossrefPubMedSearch in Google Scholar
  • 9 Griffin III CE, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J 2013; 13 (02) 214-223
    PubMedSearch in Google Scholar
  • 10 Li JK. Laminar and turbulent flow in the mammalian aorta: Reynolds number. J Theor Biol 1988; 135 (03) 409-414
    CrossrefPubMedSearch in Google Scholar
  • 11 Sutera SP. The history of Poiseuille's Law. Annu Rev Fluid Mech 1993; 25: 1-19
    CrossrefPubMedSearch in Google Scholar
  • 12 Wells WJ, Yu RJ, Batra AS, Monforte H, Sintek C, Starnes VA. Obstruction in modified Blalock shunts: a quantitative analysis with clinical correlation. Ann Thorac Surg 2005; 79 (06) 2072-2076
    CrossrefPubMedSearch in Google Scholar
  • 13 Yuan SM, Shinfeld A, Raanani E. The Blalock-Taussig shunt. J Card Surg 2009; 24 (02) 101-108
    CrossrefPubMedSearch in Google Scholar
  • 14 Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123 (01) 110-118
    CrossrefPubMedSearch in Google Scholar
  • 15 Lucas SS, Nasr VG, Ng AJ, Joe C, Bond M, DiNardo JA. Pediatric Cardiac Intensive Care Society 2014 consensus statement: pharmacotherapies in cardiac critical care: sedation, analgesia and muscle relaxant. Pediatr Crit Care Med 2016; 17 (3, Suppl 1): S3-S15
    CrossrefPubMedSearch in Google Scholar
  • 16 Wood P. The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. I. BMJ 1958; 2 (5098): 701-709
    PubMedSearch in Google Scholar
  • 17 Bennett JM, Ehrenfeld JM, Markham L, Eagle SS. Anesthetic management and outcomes for patients with pulmonary hypertension and intracardiac shunts and Eisenmenger syndrome: a review of institutional experience. J Clin Anesth 2014; 26 (04) 286-293
    CrossrefPubMedSearch in Google Scholar
  • 18 Cheung EW, Richmond ME, Turner ME, Bacha EA, Torres AJ. Pulmonary atresia/intact ventricular septum: influence of coronary anatomy on single-ventricle outcome. Ann Thorac Surg 2014; 98 (04) 1371-1377
    CrossrefPubMedSearch in Google Scholar
  • 19 Peterson RE, Freire G, Marino CJ, Jureidini SB. Transthoracic echocardiographic assessment of coronary flow in the diagnosis of right ventricular-dependent coronary circulation in pulmonary atresia with intact ventricular septum. Pediatr Cardiol 2018; 39 (05) 967-975
    CrossrefPubMedSearch in Google Scholar
  • 20 Ayoub C, Geske JB, Larsen CM, Scott CG, Klarich KW, Pellikka PA. Comparison of Valsalva maneuver, amyl nitrite and exercise echocardiography to demonstrate latent left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Am J Cardiol 2017; 120 (12) 2265-2271
    CrossrefPubMedSearch in Google Scholar
  • 21 Odegard KC, Vincent R, Baijal R. et al. SCAI/CCAS/SPA expert consensus statement for anesthesia and sedation practice: Recommendations for patients undergoing diagnostic and therapeutic procedures in the pediatric and congenital cardiac catheterization laboratory. Catheter Cardiovasc Interv 2016; 88 (06) 912-922
    CrossrefPubMedSearch in Google Scholar
  • 22 Burch TM, McGowan Jr FX, Kussman BD, Powell AJ, DiNardo JA. Congenital supravalvular aortic stenosis and sudden death associated with anesthesia: what's the mystery?. Anesth Analg 2008; 107 (06) 1848-1854
    CrossrefPubMedSearch in Google Scholar
  • 23 Kobayashi Y, Muldoon SM, Kiyose M, Hagiwara T, Kumasaka S, Okabe E. Inhibition by midazolam of the adrenergic function in the isolated canine mesenteric vein. Acta Anaesthesiol Scand 1998; 42 (10) 1157-1163
    CrossrefPubMedSearch in Google Scholar
  • 24 Zupkó I, Jánossy K, Maul K, Márki A, Falkay G. Alpha-adrenergic blockade: a possible mechanism of tocolytic action of certain benzodiazepines in a postpartum rat model in vivo. Life Sci 2003; 72 (10) 1093-1102
    CrossrefPubMedSearch in Google Scholar
  • 25 Marhsall BE, Longnecker DE. General anesthetics. In: Gilman AG, Rall TW, Nies AS, Taylor P. eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 8th ed. New York, NY: McGraw-Hill; 1990: 285-310
    Search in Google Scholar
  • 26 Ing RJ, Ames WA, Chambers NA. Paediatric cardiomyopathy and anaesthesia. Br J Anaesth 2012; 108 (01) 4-12
    CrossrefPubMedSearch in Google Scholar
  • 27 Forman SA. Clinical and Molecular Pharmacology of Etomidate. Clinical and molecular pharmacology of etomidate. Anesthesiology 2011; 114 (03) 695-707
    CrossrefPubMedSearch in Google Scholar
  • 28 Van Berkel MA, Exline MC, Cape KM. et al. Increased incidence of clinical hypotension with etomidate compared to ketamine for intubation in septic patients: a propensity matched analysis. J Crit Care 2017; 38: 209-214
    CrossrefPubMedSearch in Google Scholar
  • 29 Page II RL, O'Bryant CL, Cheng D. et al; American Heart Association Clinical Pharmacology and Heart Failure and Transplantation Committees of the Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Drugs that may cause or exacerbate heart failure: a scientific statement from the American Heart Association. Circulation 2016; 134 (06) e32-e69
    PubMedSearch in Google Scholar
  • 30 Bovill JG. Intravenous anesthesia for the patient with left ventricular dysfunction. Semin Cardiothorac Vasc Anesth 2006; 10 (01) 43-48
    CrossrefPubMedSearch in Google Scholar
  • 31 Loomba RS, Gray SB, Flores S. Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension. Congenit Heart Dis 2018; 13 (05) 646-654
    CrossrefPubMedSearch in Google Scholar
  • 32 Tobias JD. Sedation and analgesia in paediatric intensive care units: a guide to drug selection and use. Paediatr Drugs 1999; 1 (02) 109-126
    CrossrefPubMedSearch in Google Scholar