Anesthesia for complex congenital anomalies

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Hypothermia as a means to perform direct intra-cardiac surgery was introduced in the early 1950s.1, 2 The application of this technique to the treatment of infants with complex congenital lesions was soon envisioned but not widely accepted, as serious problems were foreseen if patients were to be cooled to the levels predicted necessary to allow time for the surgical repair.3 The introduction of the oxygenator and its subsequent refinement resulted in decreased interest in pure hypothermic techniques, though induced hypothermia continued to be widely used as an adjunct to cardiopulmonary bypass. Cardio-pulmonary bypass, however, was associated with a high incidence of complications, often fatal, when applied to small infants.

The technique of profound hypothermia (15 C) with circulatory and respiratory arrest was described by Drew and Anderson4 in 1959. In 1963 Horiuchi et al5 reported the use of simple (without cardiopulmonary bypass) deep hypothermia (25 C) for the correction of ventricular septal defect in infancy. During the past 17 years the use of hypothermia with circulatory arrest for the correction of congenital heart defects during infancy has been reported.6–9 Reported results of cardiac surgery in infants indicated that for many lesions the mortality following early definitive operation was less than the combined mortality following a palliative procedure and subsequent total correction. In addition early corrective surgery was recognized as offering other possible advantages: avoidance of the complications of the uncorrected cardiac disease, acceleration of retarded physical and intellectual functions, and lessening of stress on the parents. For all these . . .



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