Anesthetic management of neonates undergoing diagnostic and therapeutic cardiac catheterization: a systematic literature review

Valencia-Arango, Lina M.; Fajardo-Escolar, Angélica P.; Segura-Salguero, Juan C.; Sáenz-Quispe, Santiago; Rincón-Restrepo, Carolina; Posada, Adriana; Ronderos, Vivian; Perea-Bello, Ana H.

doi:10.1016/j.bjane.2020.06.005

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Systematic Review • Rev. Bras. Anestesiol. 70 (3) • May-Jun 2020 • https://doi.org/10.1016/j.bjane.2020.06.005 copy

Anesthetic management of neonates undergoing diagnostic and therapeutic cardiac catheterization: a systematic literature review^☆ ☆ Department of Anesthesia, Javeriana University School of Medicine, Bogotá, Colombia.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Several interventional cardiology procedures are required in neonates with congenital heart disease. Interventional cardiology procedures have a higher risk of cardiac arrest compared to other interventions. At present, there is great heterogeneity in the perioperative management of congenital heart disease neonates undergoing diagnostic cardiac catheterization or therapeutic cardiac catheterization.

Study objectives:

Primary aim: Provide a systematic review of the most effective and/or safe anesthetic and perioperative management in neonates with congenital heart disease who undergo diagnostic cardiac catheterization or therapeutic cardiac catheterization. Secondary aim: Identify the medications, monitoring parameters and airway management used in the same population.

Design:

Systematic literature review.

Setting:

Catheterization laboratory.

Methods:

Literature was searched (December 2017) in electronic databases Medline, EMBASE, ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database.

Main results:

From 130 records identified, four studies met inclusion criteria and quality assessment. None of the studies were relevant to the primary objective. Regarding the secondary objectives, one study compared the efficacy and adverse effects of racemic ketamine and its S(+) ketamine enantiomer, one study reported the efficacy of subarachnoid anesthesia for high-risk children undergoing diagnostic cardiac catheterization, one study identified the factors associated to high severity adverse events related to sedation, anesthesia and airway, and one study retrospectively analyzed cardiac catheterization procedures in neonates weighing less than 2.5 kg.

Conclusion:

There are no evidence-based recommendations available for congenital heart disease neonates undergoing cardiac catheterization. More studies are required to evaluate the ideal anesthetic and perioperative management in this population.

KEYWORDS
Cardiac catheterization; Newborn infant; Premature infant; Anesthesia; Perioperative care; Heart diseases

First author, year, country	Type of study	Patients/ Procedures	Patient characteristics	Factor(s) prognosis	Follow-up duration	Outcome measures	Results
Simpson JM, 2001; United Kingdom ¹³13 Simpson JM, Moore P, Teitel DF. Cardiac catheterization of low birth weight infants. Am J Cardiol [Internet]. 2001;87:1372-7. Available from: http://www.sciencedirect.com/science/article/pii/S0002914901015557 http://www.sciencedirect.com/science/art...	Case series	Interventional procedures: Patients: 29 (31 procedures); Male/Female: 16/15 (52/48%); Average age (days): 5 (1-126). Average weight (kg): 2.1 (0.7-2.4). Ventilation: Controlled 21(65%), spontaneous ventilation 8(35%).	Neonates with congenital heart disease and weight ≤ 2.5 kg.	Preterm neonates with low weight at the time of the procedure (≤ 2.5 kg)	General: 24 h post-procedure.	Major/minor complications occurred up to 24 h after the procedure.	Interventional procedures (n = 31) - Arterial catheter: 6 (19%) - Venous access in 29 (94%) Complications: -Mortality: 3(4%). -Non-fatal major 12(15%) -Minor 11(14%). -Incidents 2(2%). - Complications in intervention 35/80 (43%) vs. diagnoses: 13/80(16%) (p = 0.009).
			Various cardiopathies.		Pulmonary Balloon valvuloplasty patients: 31 months (1-10 years) post- procedure.
			Diagnostic: 80
			Therapeutic: 31
		Diagnostic procedures: Patients: 80. Average age (days): 9 (1-135). Average weight (kg): 2.3 (1.1-2.49). Ventilation: Controlled 45(56%), spontaneous ventilation 8(35%).
							Respiratory deterioration requiring ventilation and orotracheal intubation (OTI): 3 (10%) in intervention and 1(1%) diagnosis.
Katznelson R, 2005; Israel ¹¹11 Katznelson R, Mishaly D, Hegesh T, et al. Spinal anesthesia for diagnostic cardiac catheterization in high-risk infants. Paediatr Anaesth. 2005;15:50-3.	Case series	12 patients	Average age: 16.85 weeks (range 0.5-48, median 8.5).	History of prematurity.	24 hours	Average anesthesia time: 98.3 min (range 8 0-1 20, median 100).	SA can be useful and safe for neonates
		Premature	Average age: 16.85 weeks (range 0.5-48, median 8.5).
		Subarachnoid anesthesia (SA)	Average weight: 4,810 g (range 2,680-8,000, median 4,257.5)
			Average weight: 4,810 g (range 2,680-8,000, median 4,257.5)			Average procedure time: 75.08 min (range 45-115, median 74).
			Procedure: diagnostic cardiac catheterizations (varied cardiac pathologies)			Additional IV sedation: Required in 6 patients (was done with midazolam).
Lin CH, 2015; USA ⁵5 Lin CH, Desai S, Nicolas R, et al. Sedation and anesthesia in pediatric and congenital cardiac catheterization: a prospective multicenter experience. Pediatr Cardiol. 2015;36:1363-75.	Analytical study, prospective cohort	Total of patients: 13,611.	Age: < 1 month 890, < 1-< 12months 2,467, 1-9 years 5,212, 1 0-1 7 years 2,939, >18 years 2,103	Pediatric patients/ congenital heart disease:	Patients undergoing cardiac catheterization between February 1^st, 2007, and June 31^st, 2010, in 8 USA institutions.	Occurrence of complications	Adverse event: hypotension 93 cases (0.68%).
		Neonates: 890		Pediatric patients/ congenital heart disease:		Rates (for patients)	Adverse event: hypotension 93 cases (0.68%).
		Under 18 years old: 11,508	Weight: <4 kg 1,161, 4-9 kg 2,944, 1 0-1 9 kg 3,267, >20 kg 6,234	Complications related to sedation		Adjusted rates (for institutions participating in C3PO)	Predictors of adverse events: -Low weight: <4 kg and weight 4-19 kg, -Presence of non-cardiac comorbidity -Low mixed venous oxygen saturation (single ventricle <50% or two ventricles)
			Gender: Male 7189, female 6422	Complications related to airway management 5-level severity scale/ CHARM
			Gender: Male 7189, female 6422				Predictors of conversion from spontaneous breathing to intubation -Minor patients -Patients undergoing high- risk procedure -Patients with inotropic support
Pees C, 2003, Germany ¹⁰10 Pees C, Haas NA, Ewert P, et al. Comparison of analgesic/sedative effect of racemic ketamine and S(+)-ketamine during cardiac catheterization in newborns and children. Pediatr Cardiol. 2003;24:424-9.	Double-blind clinical trial	100 patients (50 patients racemic ketamine/ 50 patients S(+) ketamine). Non- randomized	Age: 2 days-11 years	Induction: Oral midazolam: 0.5 mg.kg^-1 -IV Midazolam: 0.2 mg.kg^-1 -Racemic ketamine/ S(+): 1 mg.kg^-1	Total doses of ketamine	Trans-operative/ post-anesthesia care unit	Dose: -Racemic ketamine: 3.12 mg/kg/h -S(+) ketamine: 2.28 mg/kg/h
			Different types of congenital heart disease.		Awakening time
					Movements
					Awareness,
					Airway obstruction		Side effects: -Inadequate sedation -Airway obstruction -Vomiting -Awareness, movement, behavior, nausea/ vomiting score
				Maintenance: -Racemic ketamine/ S(+): 0.5 mg.kg^-1 as needed -Midazolam: 0.1 mg.kg^-1	Nausea/ vomiting
					Need for other medications.
				Rescue (exclusion): -Phenobarbital -Promethazine	Need for other medications.

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail: perea.a@javeriana.edu.co (A.H. Perea-Bello).

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Anesthetic management of neonates undergoing diagnostic and therapeutic cardiac catheterization: a systematic literature review☆ ☆ Department of Anesthesia, Javeriana University School of Medicine, Bogotá, Colombia.

Abstract

Background:

Study objectives:

Design:

Setting:

Methods:

Main results:

Conclusion:

Anesthetic management of neonates undergoing diagnostic and therapeutic cardiac catheterization: a systematic literature review^☆ ☆ Department of Anesthesia, Javeriana University School of Medicine, Bogotá, Colombia.