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Cover
Title Page
1. Copyright
List of Contributors
Preface
List of Abbreviations
About the Companion Website
Part I History, Education, Outcomes, and Science
1. Chapter 1: History of Anesthesia for Congenital Heart Disease
  1. Introduction
  2. The first years: 1938–1954
  3. The heart–lung machine: 1954–1970
  4. The era of deep hypothermic circulatory arrest and the introduction of PGE₁: 1970–1980
  5. The story of HLHS: 1980–1990
  6. Fontan and the catheterization laboratory: 1990–2000
  7. Emergence of technology, including imaging (TEE, MRI) and ECMO: 2000–2010
  8. 2011–2015 and the future
  9. CHD – a growing specialty from the fetus to the adult patient
  10. Selected references
2. Chapter 2: Education for Anesthesia in Patients with Congenital Cardiac Disease
  1. Introduction
  2. Why teach and learn congenital cardiac anesthesia?
  3. The current model
  4. Curriculum for learning and teaching congenital cardiac anesthesia
  5. Curriculum maintenance and enhancement
  6. Dissemination
  7. Role of professional societies
  8. Conclusion
  9. Selected References
3. Chapter 3: Quality, Outcomes, and Databases in Congenital Cardiac Anesthesia
  1. Introduction
  2. Errors and outcomes in surgery and anesthesia
  3. The six “Cs”: communication and teamwork
  4. Databases in pediatric cardiac surgery and anesthesiology
  5. Prospective risk assessment in pediatric cardiac surgery and cardiology
  6. Closed claims analysis in anesthesia
  7. Pediatric and congenital cardiac anesthesia morbidity and mortality
  8. CCAS and the Congenital Cardiac Anesthesia Network (CCAN)
  9. Joint CCAS–STS database initiative
  10. International efforts
  11. Selected References
4. Chapter 4: Development of the Cardiovascular System and Nomenclature for Congenital Heart Disease
  1. Introduction
  2. Development of the cardiovascular system
  3. Nomenclature for congenital heart disease
  4. Selected References
5. Chapter 5: Physiology and Cellular Biology of the Developing Circulation
  1. Introduction
  2. Development from fetus to neonate
  3. Development from neonate to older infant and child
  4. Development from child to adult
  5. Normal values for physiologic variables by age
  6. Myocardial sequelae of longstanding CHD
  7. Cardiomyocyte receptor function in normal and diseased hearts
  8. Regulation of vascular tone in systemic and pulmonary circulations
  9. Receptor signaling in myocardial dysfunction, CHD, and heart failure
  10. Myocardial preconditioning
  11. Selected References
6. Chapter 6: Anesthetic Agents and Their Cardiovascular Effects
  1. Introduction
  2. Volatile agents
  3. Nitrous oxide (N₂O)
  4. Opioids and benzodiazepines
  5. Propofol
  6. Ketamine
  7. Etomidate
  8. Dexmedetomidine
  9. Special conditions affecting anesthetic pharmacokinetics and pharmocodynamics in congenital cardiac anesthesia
  10. Neuromuscular blocking agents and antagonists
  11. Selection of anesthetic regimen in CHD
  12. Selected References
7. Chapter 7: Cardiopulmonary Bypass
  1. Introduction
  2. Basic bypass circuit setup
  3. Differences between pediatric and adult CPB circuitry
  4. Management of pediatric CPB
  5. Effects of CPB on organ systems
  6. Special CPB management issues
  7. Monitoring anticoagulation during and after CPB
  8. Complications and safety
  9. Conclusions and future perspectives
  10. Selected references
8. Chapter 8: Multiorgan Effects of Congenital Cardiac Surgery
  1. Introduction
  2. The systemic inflammatory response and congenital cardiac surgery
  3. Mitigating the deleterious inflammatory effects of CPB
  4. Effects of congenital heart surgery on coagulation, hemostasis, and thrombosis
  5. Pulmonary effects of congenital heart surgery
  6. Renal effects of congenital heart surgery
  7. Gastrointestinal and hepatic consequences of cardiac surgery in children
  8. Endocrine response and pediatric cardiac surgery
  9. Selected References
9. Chapter 9: Anesthetic and Sedative Neurotoxicity in the Patient with Congenital Heart Disease
  1. Introduction
  2. Preclinical studies in animal and tissue culture models
  3. Mechanisms of anesthesia-induced neurotoxicity
  4. Summary of human cardiac cohorts
  5. Experimental therapy in preclinical studies
  6. Future therapy
  7. Directions for future research
  8. Conclusion
  9. Selected references
Part II Monitoring
1. Chapter 10: Vascular access and monitoring
  1. Introduction
  2. Venous access
  3. Arterial access
  4. Ultrasound guidance for vascular access in congenital heart surgery
  5. Percutaneous PA catheterization
  6. Interpretation of intravascular pressure waveforms
  7. New techniques in pediatric intravascular monitoring
  8. Complications of vascular access
  9. Conclusions
  10. Selected References
2. Chapter 11: Neurological Monitoring and Outcome
  1. Introduction
  2. Cerebrovascular physiology during cardiac surgery
  3. Neurological monitoring during congenital heart surgery
  4. Longer-term neurodevelopmental testing outcomes after congenital heart surgery
  5. Conclusions
  6. Selected References
3. Chapter 12: Transesophageal Echocardiography in Congenital Heart Disease
  1. Introduction
  2. Indications for TEE in CHD
  3. Contraindications to TEE
  4. TEE hardware
  5. TEE Examination in CHD
  6. Summary
  7. Acknowledgement
  8. Selected references
4. Chapter 13: Coagulation, Cardiopulmonary Bypass, and Bleeding
  1. Introduction
  2. Coagulation
  3. CPB-associated coagulation changes
  4. Management of bleeding after CPB
  5. Blood conservation
  6. Summary
  7. Selected References
Part III Preoperative Considerations
1. Chapter 14: Preoperative Evaluation and Preparation
  1. Introduction
  2. Preoperative evaluation
  3. Laboratory evaluation
  4. Preoperative imaging studies
  5. Preoperative preparation
  6. Risk stratification
  7. Selected references
2. Chapter 15: Approach to the Fetus, Premature, and Full-Term Neonate
  1. Introduction
  2. Approach to treatment in the neonate
  3. Outcome
  4. Premature infants and very LBW neonates
  5. Fetal cardiac intervention and surgery
  6. Selected references
3. Chapter 16: Approach to the Adult Patient
  1. Introduction
  2. Non-cardiac sequelae of CHD
  3. Vascular access considerations
  4. Unrestricted shunts
  5. Pregnancy
  6. Adults with Down syndrome
  7. Psychological issues
  8. Cardiac lesions
  9. Transplant and the ACHD patient
  10. Non-cardiac surgery in the adult with CHD
  11. Conclusions
  12. Selected references
Part IV Management
1. Chapter 17: Hemodynamic management
  1. Introduction: hemodynamic management following congenital heart surgery: a goal-directed approach
  2. The VO₂/DO₂ balance following CHD surgery
  3. Improving postoperative oxygen transport balance: preventive and therapeutic interventions
  4. Cardiopulmonary interactions
  5. Monitoring
  6. Extracorporeal membrane oxygenation support
  7. Postoperative management: lesion-specific
  8. Selected references
2. Chapter 18: Arrhythmias: Diagnosis and Management
  1. Introduction
  2. Cardiac rhythm disturbances
  3. Pharmacologic therapy of cardiac arrhythmias
  4. Pacemaker therapy in children
  5. Summary
  6. Acknowledgement
  7. Selected references
3. Chapter 19: Airway and Respiratory Management
  1. Introduction
  2. Choosing the appropriate endotracheal tube
  3. The difficult airway
  4. Airway and ventilatory management for thoracic surgery
  5. Changes in lung function in children with CHD
  6. Mechanical ventilation for children with CHD
  7. Specialized problems
  8. Summary
  9. Selected references
4. Chapter 20: Early Tracheal Extubation and Postoperative Pain Management
  1. Introduction
  2. Background and history
  3. Feasibility of fast-tracking in congenital heart surgery
  4. Patient selection
  5. Anesthesia technique
  6. Surgery and CPB considerations
  7. Failed extubation and prolonged mechanical ventilation
  8. Benefits of fast-tracking
  9. Concerns and safety of fast-tracking
  10. Postoperative considerations
  11. Neuraxial techniques
  12. Regional blocks
  13. Conclusions
  14. Selected references
Part V Anesthesia for Specific Lesions
1. Chapter 21: Anesthesia for Left-to-Right Shunt Lesions
  1. Introduction
  2. Patent ductus arteriosus
  3. Aortopulmonary window
  4. Atrial septal defects
  5. Ventricular septal defects
  6. Atrioventricular canal
  7. Double outlet right ventricle
  8. Truncus arteriosus
  9. Partial and total anomalous pulmonary venous return
  10. Selected references
2. Chapter 22: Anesthesia for Left–sided Obstructive Lesions
  1. Introduction
  2. Aortic valve stenosis
  3. Subvalvular aortic stenosis
  4. Supravalvular aortic stenosis
  5. Hypertrophic cardiomyopathy
  6. Coarctation of the aorta
  7. Interrupted or hypoplastic aortic arch
  8. Shone's anomaly
  9. Mitral stenosis
  10. Selected references
3. Chapter 23: Anesthesia for Right-sided Obstructive Lesions
  1. Introduction
  2. Ebstein's anomaly
  3. Tetralogy of Fallot
  4. Pulmonary stenosis with intact ventricular septum
  5. Pulmonary atresia with intact ventricular septum
  6. Pulmonary atresia/VSD/MAPCAs
  7. Summary
  8. Selected references
4. Chapter 24: Anesthesia for Transposition of the Great Arteries
  1. Introduction
  2. Physiologically uncorrected TGA
  3. Congenitally corrected TGA
  4. Selected references
5. Chapter 25: Anesthesia for the Patient with a Single Ventricle
  1. Introduction
  2. Hypoplastic left heart syndrome
  3. Tricuspid atresia
  4. Other forms of univentricular hearts
  5. Superior cavopulmonary anastomosis
  6. Fontan completion
  7. Heart transplantation for single-ventricle malformations
  8. Non-cardiac surgery and anesthesia for the patient with a single ventricle
  9. Summary
  10. Selected references
6. Chapter 26: Anesthesia for Miscellaneous Cardiac Lesions
  1. Introduction
  2. Vascular rings
  3. Anomalies of the coronary arteries
  4. Pericardial effusion and tamponade
  5. Mitral regurgitation
  6. Cardiac tumors in childhood
  7. Aortic aneurysm and aortopathy in children
  8. Mediastinal masses
  9. Selected references
7. Chapter 27: Anesthesia for Cardiac and Pulmonary Transplantation
  1. Heart transplantation
  2. Pediatric lung transplantation
  3. Selected references
8. Chapter 28: Anesthesia for Pulmonary Hypertension
  1. Incidence, anatomy, and natural history
  2. Pathophysiology of PH in CHD
  3. Assessment of PH
  4. Medical management of pulmonary arterial hypertension
  5. Perioperative risk considerations
  6. Anesthetic management
  7. Conclusions
  8. Selected references
Part VI Anesthesia Outside the Cardiac Operating Room
1. Chapter 29: Anesthesia for the Cardiac Catheterization Laboratory
  1. Introduction to the cardiac catheterization laboratory
  2. Diagnostic catheterization
  3. Interventional cardiology
  4. Electrophysiology procedures
  5. Conclusions
  6. Acknowledgements
  7. Selected references
2. Chapter 30: Anesthesia for Non-cardiac Surgery and Magnetic Resonance Imaging
  1. Introduction
  2. Preoperative preparation for non-cardiac surgery
  3. Pacemakers and defibrillators
  4. The patient on ventricular assist device support
  5. Management strategies for the stages of single-ventricle palliation
  6. High-risk patient groups
  7. Intraoperative care
  8. Magnetic resonance imaging and computed tomography
  9. Postoperative considerations
  10. Selected references
3. Chapter 31: Cardiac Intensive Care
  1. Introduction
  2. Pathophysiology of specific congenital cardiac defects and implications
  3. Airway and ventilation management
  4. Myocardial dysfunction and hemodynamic monitoring
  5. Cardiopulmonary resuscitation in the CICU
  6. Management of postoperative complications
  7. Patient safety and quality improvement in the CICU
  8. Mechanical support of the circulation
  9. Hemostasis
  10. Infection control
  11. Neurologic monitoring/assessment and complications
  12. Fluid management and renal dysfunction
  13. Nutrition and gastrointestinal complications
  14. Selected references
4. Chapter 32: Mechanical Support of the Circulation
  1. Background, introduction, and history
  2. Indications for mechanical support
  3. Contraindications to mechanical support in children
  4. Devices
  5. Role of echocardiography in mechanical support
  6. Weaning from circulatory support
  7. Anesthesia, analgesia, and sedation for mechanical support
  8. Anticoagulation, antifibrinolytics, and platelet anti-aggregation therapies
  9. Anti-infective therapy
  10. Outcomes and complications of extracorporeal support
  11. The future
  12. Selected references
Appendix: Texas Children's Hospital Pediatric Cardiovascular Anesthesia Drug Sheet (April 2015)
1. References
  1. Index
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