Article

Anesthetic management of neonates undergoing palliative operations for congenital heart defects

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Abstract

Considerable progress has been made in the treatment of congenital heart defects in patients of all ages during the past 2 decades. Further advances have been made in neonates and infants in the past decade. The application of open heart surgical techniques in this group has been enhanced by the use of deep hypothermic circulatory arrest. Palliative or partial corrections have been used in neonates for either of two reasons: (1) mortality associated with complete repair was too high, or (2) definitive repair for many types of defects was not possible. Although these principles are applicable in some cases today, definitive corrective operations have been successfully accomplished for most cardiac defects. Improved techniques and success of deep hypothermic cardiopulmonary bypass in neonates and infants have led many to challenge the traditional concepts of palliative closed heart operations.1–4 Since the risks of operations in these patients are related largely to intraoperative events, their anesthetic management is of considerable importance.5 Accordingly, we have analyzed our experience with palliative closed heart operations in neonates and infants during the past 20 years.

Patients

From January 1, 1960, to December 31, 1979, 675 patients underwent closed palliative surgical procedures at the Cardinal Glennon Memorial Hospital for Children* (Table 1). Of these, 378 (56%) were younger than one year old at the time of operation and 297 (44%) were older. About one fourth of the total number (169 patients) were neonates younger than one month). We have compared postoperative survival in neonates with that . . .


 

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