New guidance issued for sedating pediatric patients with heart disease
November 08, 2016
by Lee Nelson
, Contributing Reporter
New recommendations have been developed to help save the lives of the youngest congenital heart disease patients during surgery.
"Practices regarding the way sedation is administered are highly variable across U.S. hospital systems and institutions," said Dr. Robert Vincent, pediatric cardiologist at Children's Healthcare of Atlanta, in a statement.
He was the lead author in a recent paper outlining recommendations established by the Society for Cardiovascular Angiography and Interventions (SCAI), the Society for Pediatric Anesthesia (SPA) and the Congenital Cardiac Anesthesia Society (CCAS).
The paper, “SCAI/CCAS/SPA Expert Consensus Statement for Anesthesia and Sedation Practice: Recommendations for Patients Undergoing Diagnostic and Therapeutic Procedures in the Pediatric and Congenital Cardiac Catheterization Laboratory,” was published recently in Catheterization and Cardiovascular Interventions, the official journal of SCAI.
"We developed these recommendations to alert and educate physicians and hospital administrators to the complex and dynamic challenges they may face when treating pediatric patients with congenital heart disease,” said Vincent.
The recommendations are to guide doctors, institutions and physicians when diagnosing and treating pediatric patients in the catheterization laboratory. Studies have shown that pediatric patients, especially those with congenital heart disease, are at increased risk of several adverse consequences and even cardiac arrest during surgery.
The cardiac arrest rate was 2.9 per 10,000 in children undergoing non-cardiac surgery and 127 per 10,000 in cardiac surgical procures, with a mortality rate of 1.6 of 10,000. Eighty-eight percent of those who experienced a cardiac arrest had congenital heart disease. Babies under four weeks old had the highest rate of cardiac arrest at 435/10,000 with mortality at 389/10,000.
Other common complications in children undergoing sedation or anesthesia include airway difficulties such as apnea and aspiration plus cardiovascular problems like arrhythmias and cardiac arrest. And to add to it all, they also face postoperative issues like vomiting, nausea and apnea.
Whether minimal or no sedation is used on the patient or general anesthesia is given by an anesthesiologist, the consensus statement still provides recommendations for patient monitoring before, during and after the procedure.
The report states that there is no specific anesthetic method appropriate for all patients with congenital heart disease in the catheterization laboratory, as long as the anesthesiologist understands the risks.
The panel of experts who wrote the paper hope that all those involved in a child’s procedures and care discuss the risks and strategies prior to it happening, especially for high-risk procedures.
“It is important to consider all viewpoints, including whether the procedure is truly necessary, before undertaking it,” the report said.
An expert panel from all three participating societies collaborated, with the goal to provide practitioners and institutions performing these procedures with guidance consistent with national standards developed by The Joint Commission, and to provide clinicians and institutions with consensus-based recommendations and the supporting references to encourage their application in quality improvement programs.