Anesthetic Management at İmplantation of Permanent Pacemaker for Newborn with Congenital Complete Heart Block

Abstract

Complete atrioventricular heart block is defined as non-conduction of electrical impulses from atria to ventricles. Atrial pace, independent from ventricles, is higher. Complete atrioventricular heart block begins at intrauterin life in newborns and it is called congenital complete heart block. Heart rate is the most important factor determining cardiac output among children and especially newborns. Newborns with congenital complete heart block have lower heart rate (<60 beat/min) and carry heart failure risk. Heart block is usually irreversible and affected newborns require permanent cardiac pacemaker from first week of their life. Understanding cardiovascular pathophysiology and knowing therapeutic approaches to congenital complete heart block are very important during perioperative management of these patients. In this case report we discussed general anesthetic management during implantation of permanent pacemaker for a newborn with congenital complete heart block. Key words: Anesthesia; Heart block; Newborn.

Keywords

• Anesthesia; Heart block; Newborn.

Konjenital Komplet Kalp Bloğu Olan Yenidoğanda Acil Kalp Pili Takılması Sırasında Anestezik Yönetim

Öz

Komplet atriyoventriküler kalp bloğu atriyal elektriksel uyarının ventriküllere iletilememesi olarak tanımlanır. Atriyal kalp hızı ventrikülden bağımsız olarak daha fazladır. Yenidoğanlarda komplet atriyoventriküler kalp bloğu intrauterin dönemde başladığı için konjenital komplet kalp bloğu olarak adlandırılır. Kalp hızı özellikle yenidoğanda olmak üzere çocuklukta kardiyak outputu belirleyen en önemli etkendir. Komplet konjenital kalp bloğu olan çocuklar ise düşük kalp atım hızına (<60 atım/dk) sahiptir ve kalp yetmezliği riski vardır. Kalp bloğu sıklıkla geri dönüşümsüzdür ve etkilenmiş çocuklar yaşamlarının ilk haftasında uzun süreli kalıcı kalp piline gereksinim duyarlar. Kardiyovasküler patofizyolojiyi anlamak ve konjenital komplet kalp bloklu yenidoğanların tedavi şekilleri bu çocukların perioperatif bakımı için gereklidir. Bu olgu sunumunda konjenital komplet kalp bloğu olan bir yenidoğanda kalıcı kalp pili takılması sırasında genel anestezik yönetim tartışılmıştır. Anahtar kelimeler: Anestezi; Kalp bloğu; Yenidoğan.

Anahtar Kelimeler

• Anestezi; Kalp bloğu; Yenidoğan.

References

1. Ammann J, Winter J, Sunderdieck U, Loer SA. Anesthetic
2. management of neonates with congenital complete
3. atrioventricular heart block undergoing pacemaker implantation. J Cardiothorac Vasc Anesth 2005;19:212—6.
4. Oklu E, Bulutçu FS, Yalçın Y, Ozbek U, Cakali E, Bayındır O. Which anesthetic agent alters the hemodynamic status during pediatric catheterization? Comparison of propofol versus ketamine. J Cardiothorac Vasc Anesth 2003;17:686—90. 3. O’Gara JP, Edelman JD. Anesthesia and the patient with complete congenital heart block. Anesth Analg 1981;60:906-8.
5. Linton DM, Human DG. Peri-operative management and administration of anaesthesia in children with congenital complete heart block. A case report and review. S Afr Med J 1984;66:875-6.
6. Ikemba CM, Su JT, Stayer SA, Miller-Hance WC, Eidem BW, Bezold U et al. Myocardial performance index with sevoflurane—pancuronium versus fentanyl—midazolam— pancuronium in infants with a functional single ventricle. Anesthesiology 2004;101:1298—305.
7. Laird TH, Stayer SA, Rivenes SM, Lewin MB, McKenzie ED, Fraser CD et al. Pulmonary—to—systemic blood flow ratio effects of sevoflurane, isoflurane, halothane, and fentanyl/midazolam with 100% oxygen in children with congenital heart disease. Anesth Analg 2002;95:1200—6.
8. Rivenes SM, Lewin MB, Stayer SA, Bent ST, Schoenig HM, McKenzie ED et al. Cardiovascular effects of sevoflurane, isoflurane, halothane, and fentanyl—midazolam in children with congenital heart disease: An echocardiographic study of myocardial contractility and hemodynamics. Anesthesiology 2001 ;94:223—9.

9. Piat V, Dubois MC, Johanet S, Murat |. Induction and recovery characteristics and hemodynamic responses to sevoflurane and halothane in children. Anesth Analg 1994;79:840—4.
10. Hannon JD, Cody MJ, Sun DX, Housmans PR. Effects of isoflurane and sevoflurane on intracellular calcium and contractility in pressure—overload hypertrophy. Anesthesiology 2004;101:675—86.
11. Walker A, Stokes M, Moriarty A. Anesthesia for major general surgery in neonates with complex cardiac defects. Paediatr Anaesth 2009;19:119-25.
12. Slater B, Rangel S, Ramamoorthy C, Abrajano C, Albanese CT. Outcomes after laparoscopic surgery in neonates with hypoplastic heart left heart syndrome. J Pediatr Surg 2007;42:1118—21.
13. Taylor CJ, Derrick G, McEwan A, Haworth SG, Sury MR. Risk of cardiac catheterization under anaesthesia in children with pulmonary hypertension. Br J Anaesth 2007;98:657—61.