The Post-Anesthetic Care of Pediatric Patients With Pulmonary Hypertension

Perioperative management of patients with pulmonary hypertension or those at risk for increased pulmonary vascular reactivity should focus on supporting the patient through the vulnerable period of physiologic derangements surrounding surgery, including acute alterations in pulmonary blood flow, altered pulmonary endothelial function following cardiopulmonary bypass, invasive mechanical ventilation, and adaptation to new hemodynamics following correction or palliation of congenital heart disease lesions. These patients require careful attention to each step of perioperative management by teams experienced in the care of pediatric patients with pulmonary hypertension. This article will focus on preoperative evaluation, pulmonary hypertensive crises, general principles of perioperative management, and specific pulmonary vasodilator therapies.

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Efficacy of citrulline supplementation to decrease the risk of pulmonary hypertension after congenital heart disease surgery. A local experience.

Revista de la Facultad de Ciencias Médicas de Córdoba ◽

10.31053/1853.0605.v77.n4.27936 ◽

2020 ◽

Vol 77 (4) ◽

pp. 249-253

Author(s):

Silene Silvera Ruiz ◽

Carola L Grosso ◽

Margot Tablada ◽

Marcelo Cabrera ◽

Raquel Dodelson de Kremer ◽

...

Keyword(s):

Congenital Heart Disease ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Congenital Heart ◽

Pediatric Patients ◽

Reference Level ◽

Plasma Citrulline ◽

Post Surgery ◽

Group A ◽

Group B

Pulmonary hypertension (PH) is a major cause of morbi-mortality among patients with congenital heart disease (CHD) and also a potentially severe complication after surgical repair. Oral citrulline, a precursor to NO synthesis, is safe and efficacious for decreasing the risk of postoperative PH. Objective: The aim of the present study was to investigate in pediatric patients the changes of plasma citrulline, arginine, homocysteine and nitric oxide (NO) metabolites and pulmonary artery pressures (PAP) pre-post cardiac surgery in order to describe our population status with regard to the risk of pulmonary hypertension and look for potential biomarkers for early detection and treatment. Main results/Discussion: 16 Argentine pediatric patients with CHD undergoing cardiopulmonary bypass were randomized in two groups: (A) with and (B) without perioperative citrulline supplementation. We found that plasma citrulline median levels before surgery were lower in both groups respect to referential values, probably due to the poor nutritional status of our patients; only group A surpassed post-surgery the minimum recommended level to avoid PH. Furthermore, none of the patients in group A showed mean PAP higher than 20 mmHg, whereas in group B, 67% of the measurements were ≥ than the reference level. Conclusions: We reaffirm that citrulline supplementation it is effective in reducing postoperative pulmonary hypertension and biomarkers could evidence patient status as a translational medicine application.

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PH Professional Network: The Burden of Prior Authorization for Pulmonary Hypertension Medications: A Practical Guide for Managing the Process

Advances in Pulmonary Hypertension ◽

10.21693/1933-088x-17.3.126 ◽

2018 ◽

Vol 17 (3) ◽

pp. 126-131 ◽

Cited By ~ 1

Author(s):

Traci Housten ◽

Anna M. Brown

Keyword(s):

Pulmonary Hypertension ◽

Risk Evaluation ◽

Pediatric Patients ◽

Waiting Times ◽

Prior Authorization ◽

Success Rates ◽

Professional Network ◽

Treatment Plans ◽

Rate Of Success ◽

Careful Documentation

Medications for pulmonary hypertension (PH) are expensive and often require prior authorization from insurance payers. The task of submitting prior authorization requests and appealing denials can burden PH practices with a heavy workload and delay or interrupt medical treatment. However, it is possible to reduce this burden, improve success rates, and reduce waiting times by implementing a standard office workflow for managing the prior authorization process. Such a system involves several key components: assessment of existing staff and level of expertise; dedicated office staff to oversee the process from start to finish; streamlined gathering, storage, and transmittal of patient documents; direct communication with pharmacies and Risk Evaluation Mitigation Strategy programs; and careful documentation of PH diagnosis and treatment plans for a given patient, aimed at reducing the necessity for appeals. This article reviews prior authorization strategies and systems used at PH clinics, and case studies in other therapeutic areas that demonstrate how such systems can reduce staff time and waiting time for initiation of medications while improving the rate of success. The article also describes the special challenges of requesting prior authorization for PH medications prescribed to pediatric patients.

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Is Emergence Time Related to Emergence Agitation in Pediatric Patients?

10.21203/rs.3.rs-32196/v1 ◽

2020 ◽

Author(s):

ngamjit pattaravit ◽

Orarat Karnjanawanichku ◽

Sirikarn Siripruekpong ◽

Nalinee Kovitwanawong ◽

Rongrong Reungchira-Urai ◽

...

Keyword(s):

Pediatric Patients ◽

Separation Anxiety ◽

Statistical Significance ◽

Anesthetic Management ◽

Multivariate Logistic Regression Analysis ◽

Behavioral Changes ◽

Emergence Agitation ◽

Emergence Time ◽

Anesthetic Care ◽

Processed Eeg

Abstract Background: Emergence agitation is one of the unpleasant symptoms after general anesthesia, especially in pediatric patients. This study was designed to evaluate the correlation between emergence time and emergence agitation. The predictors associated with emergence agitation and behavioral changes in children was also determined as specific outcomes.Methods: This prospective cohort study was conducted in children undergoing anesthesia between 3 to 12 years. The preoperative unit nurse evaluated the child's baseline behaviors preoperatively. From pre to post anesthesia period, nurse anesthetist recorded anesthetic management data and clinical emergence time. Meanwhile, the investigator team recorded the Processed-EEG emergence time. At the Post-Anesthetic Care Unit (PACU), the well trained PACU nurse evaluated clinical emergence time and emergence symptoms. For the behavioral symptoms, the investigator team evaluated any changes by telephone interview at postoperative days 1, 3, and 7. Statistical significance was set at p <0.05. Results: Ninety-one pediatric patients were enrolled in the study. Preoperative baseline behaviors were not related to emergence agitation or behavioral changes. There were correlations between clinical emergence time and the incidences of emergence agitation and postoperative separation anxiety. There was no relationship found between processed-EEG emergence time and the incidence of emergence agitation. Multivariate logistic regression analysis showed the significant predictors (ASA physical status, clinical emergence time, and pain) to predict Emergence agitation. (AUC=0.92, sensitivity = 0.89, specificity 0.81). Separation anxiety was significantly higher at postoperative days 1,3 and 7 in the children with emergence agitation (p-values = 0.020, 0.020, and 0.017, respectively).Conclusion: Clinical emergence time significantly related to emergence agitation and postoperative separation anxiety.Trial registration: ClinicalTrials.gov Identifier: NCT03358069. Registered 18 January 2017 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0007IOW&selectaction=Edit&uid=U0001FGB&ts=2&cx=-7ofx36

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