Remifentanil‐based fast‐track cardiac anesthesia combined with the postoperative serratus anterior plane block for transthoracic device closure of atrial septal defect in pediatric patients

Background: To investigate the safety and efficacy of remifentanil combined with dexmedetomidine in fast-track cardiac anesthesia (FTCA) for transthoracic device closure of atrial septal defect (ASD) in pediatric patients. Methods: A retrospective analysis was performed on 61 cases of children undergoing ASD closure through a small thoracic incision from January 2018 to January 2020. According to whether FTCA was administered, they were divided into group F (fast-track anesthesia, n = 31) and group R (routine anesthesia, n = 30). Results: There was no significant difference in general preoperative data, perioperative hemodynamics, or postoperative pain scores between the 2 groups (P > .05). The postoperative sedation score of group F was higher than that of group R 1 and 4 hours after extubation. Meanwhile, duration of mechanical ventilation and length of postoperative intensive care unit (ICU) stay of group F were significantly shorter than those of group R (P < .05). No serious anesthesia-related complications occurred. Conclusion: Remifentanil combined with dexmedetomidine in FTCA for transthoracic device closure of ASD in pediatric patients is safe and effective, is worthy of clinical promotion, and can benefit more children.

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Clinical application of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block in right-thoracoscopic minimally invasive cardiac surgery: a retrospective cohort study

10.22541/au.164115758.88166074/v1 ◽

2022 ◽

Author(s):

Shenjie Jiang ◽

Xiaokan Lou ◽

Meijuan Yan

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Clinical Application ◽

Fast Track ◽

Minimally Invasive Cardiac Surgery ◽

Cardiac Anesthesia ◽

Opioid Use ◽

Serratus Anterior ◽

Extubation Time ◽

Anterior Plane

Objectives: This study aimed to investigate the effects of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block on the post-operative rehabilitation of patients undergoing right-sided thoracoscopic minimally invasive cardiac surgery, as well as the safety and feasibility of the clinical application of this technique. Background: Regional nerve block has previously been used in cardiac surgery to reduce intraoperative opioid use and promote anesthesia in fast-track and ultra-fast-track cardiac surgery. However, the clinical application of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) in minimally invasive cardiac surgery under thoracoscopy has not been reported. Methods: A total of 102 patients who underwent right-sided thoracoscopic minimally invasive heart valve surgery in our center from January 2021 to August 2021 were enrolled and divided into two groups: an ultrafast channel cardiac anesthesia assisted by serratus anterior plane block (SAPB-GA) group (n=40) and a conventional general anesthesia (GA) group (n=62). The effects of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) on post-operative rapid recovery as well as the safety and feasibility of its clinical application were compared and analyzed. Results: Compared to the GA group, the intraoperative use of sufentanil in the SAPB-GA group was significantly reduced (66.25±1.025, 283.31±11.362, P<0.001); the incidence of postoperative analgesia in ICU was significantly decreased (17%, 48.8%, P<0.001); the incidence of postoperative NRS≥3 in ICU was significantly decreased (15%, 37.1%, P = 0.016); and the postoperative extubation time (1(1-1), 13.84 (10.25-18.36), P<0.001), ICU stay time (28.58±2.838, 61.69±4.125, P<0.001) and postoperative hospital stay (8.08±0.313, 9.74±0.356, P=0.02) were significantly shortened; and the 24 h postoperative thoracic blood drainage was significantly reduced (209.63±25.645, 318.23±20.713, P<0.001). No statistical difference was observed in the incidence of postoperative nausea, vomiting and atelectasis between the two groups (all P>0.05). Both of the groups reported no postoperative cardiovascular events. Conclusions: Ultrafast channel cardiac anesthesia assisted by SAPB could promote the rapid postoperative recovery of patients undergoing minimally invasive cardiac surgery under a thoracoscope. This approach is safe and feasible in the clinic.

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Acute Changes in Left Ventricular End Diastolic Pressure following the Transcatheter Closure of an Atrial Septal Defect in Adults

The Heart Surgery Forum ◽

10.1532/hsf.1442 ◽

2016 ◽

Vol 19 (3) ◽

pp. 145 ◽

Cited By ~ 1

Author(s):

Young Hwa Kong ◽

Jinyoung Song ◽

Kyung Hee Kim ◽

June Huh ◽

I-Seok Kang

Keyword(s):

Elderly Patients ◽

Atrial Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Diastolic Pressure ◽

Left Ventricular Diastolic Function ◽

Left Ventricular ◽

Device Closure ◽

Acute Changes ◽

Asd Closure

Background: Acute changes in left ventricular diastolic function shortly after ASD closure in elderly patients have not been well known. We aimed to investigate acute changes in left ventricular end diastolic pressure (LVEDP) in elderly patients following transcatheter closure of atrial septal defect (ASD). Methods: All 19 adults with ASDs who underwent transcatheter closure between June 2013 and December 2014 were enrolled. LVEDP was measured prior to device closure and compared with that immediately following device closure and 15 minutes after device closure. Results: The median age of the patients was 48 years old. The baseline E/e’ and LVEDP values were 8.3 ± 2.8 and 13 ± 3 mmHg. The LVEDP value immediately following closure was 19 ± 4 mmHg, and 15 minutes after closure was 16 ± 4 mmHg. The median increase in the LVEDP value immediately following closure was 6 mmHg, which significantly differed from that prior to closure. The LVEDP 15 minutes after closure decreased but remained significantly higher than the value observed immediately after closure. No significant changes were observed with regard to E/e’ at either 1 day or 3 months following closure. The LVEDP value 15 minutes after device closure was significantly correlated with those observed before closure and immediately following closure; however, no significant correlations were observed with regard to patient age, Qp/Qs, E/e’ before closure, or E/e’ 3 months after device closure. Conclusion: LVEDP in adults with ASDs significantly increases following device closure. LVEDP before closure predicts LVEDP following device closure.

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Use of Mullins sheath to prevent prolapse of Gore Cardioform ASD Occluder in a child with severe scoliosis

Cardiology in the Young ◽

10.1017/s1047951120004242 ◽

2020 ◽

pp. 1-3

Author(s):

Christopher Herron ◽

Daisuke Kobayashi

Keyword(s):

Atrial Septal Defect ◽

Right Atrium ◽

Septal Defect ◽

Device Closure ◽

Severe Scoliosis ◽

The Right ◽

Transcatheter Device ◽

Delivery Catheter

Abstract Transcatheter device closure of an atrial septal defect (ASD) may require an additional supportive technique in challenging cases. We report a 15-year-old male with moderate-sized ASD and severe scoliosis. In spite of adequate positioning of the Gore Cardioform ASD occluder, the device was pulled into the right atrium by a retrieval cord due to the acute release of strong tension between the delivery catheter and its device upon locking. This phenomenon was prevented by the use of Mullins sheath, resulting in a successful release of the device. The use of a Mullins sheath may be considered to deliver a Gore Cardioform ASD device in selected cases.

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Impact of Transcatheter Device Closure of Atrial Septal Defect on Atrial Arrhythmias Propensity in Young Adults

Pediatric Cardiology ◽

10.1007/s00246-019-02221-0 ◽

2019 ◽

Vol 41 (1) ◽

pp. 54-61

Author(s):

Michel Cabrera Ortega ◽

Dunia Bárbara Benítez Ramos ◽

Juan Carlos Ramiro Novoa ◽

Francisco Javier Ozores Suarez ◽

Francisco Díaz Ramírez ◽

...

Keyword(s):

Young Adults ◽

Atrial Septal Defect ◽

Septal Defect ◽

Atrial Arrhythmias ◽

Device Closure ◽

Transcatheter Device

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Case report: echocardiographic detection of rare single coronary artery anomaly in a child with an atrial septal defect

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab283 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Rachel Hazaert ◽

Nigel Wilson ◽

Kathryn Rice

Keyword(s):

Coronary Artery ◽

Atrial Septal Defect ◽

Septal Defect ◽

Incidental Finding ◽

Dobutamine Stress ◽

Single Coronary Artery ◽

Device Closure ◽

Coronary Artery Anatomy ◽

Transcatheter Device ◽

Single Coronary Artery Anomaly

Abstract Background A single right coronary artery (RCA) with the left anterior descending (LAD) and circumflex coronary arteries located in the usual anatomic position and supplied by collaterals is the rarest variant of single RCA. Case summary We report a paediatric patient with an incidental finding of single RCA Lipton type RI pattern during assessment for transcatheter device closure of an ostium secundum atrial septal defect (secASD). Transthoracic echocardiography (TTE) revealed a dilated RCA, abnormal flow in the LAD, and no identifiable left main coronary artery. Diagnosis of a single RCA was confirmed with angiography. Dobutamine stress echocardiography revealed no inducible ischaemia. Transcatheter device closure of the secASD was subsequently successfully performed. Discussion TTE in paediatric patients can raise suspicion of coronary artery origin anomalies. Additional modalities, such as computed tomography and angiography, are required to comprehensively determine coronary artery anatomy. Functional assessment of ventricular function is also indicated. Coronary artery anatomy is important to delineate prior to transcatheter device closure of a secASD and should be part of the pre-procedure assessment.

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