Peri-operative Anesthetic Innovations During Pediatric Cardiac Surgery

Congenital heart disease (CHD) refers to a series of birth defects that aff ect the heart and thoracic vessels, aff ecting 6 to 8 out of 1,000 babies being born. In 40% of these children no treatment is indicated because of minimal eff ect on hemodynamics and outcome. In 60% treatment will be required; about half of them will require urgent surgery after birth, while the other half will probably require surgery or medication at some point during childhood. Due to advances in heart surgery, 85% of children with congenital heart disease will survive into adulthood. Although CHD has been recognized for centuries, therapeutic options were not available until the 20th century. Until the late 1930s little advances were made in cardiac surgery due to a lack of refi nement in anesthesia and problems related to now routine perioperative support techniques, such as blood transfusion and mechanical ventilation. After the fi rst successful ligation of a patent ductus arteriosus in 1938, a lot of new operations found their origin. In 1949 perioperative mortality, approached 14.5%. In the 1950s extracorporeal circulation made its entry. The introduction of new anesthetic drugs and the use of prostaglandins to maintain ductal patency and pulmonary blood fl ow was one of the most important advances of the 1970s. In the late 1970s cardioplegia solutions were introduced. During the 1980s sufentanil and midazolam off ered alternatives to potent volatile anesthetics, although hospital mortality was still 6%. From the 1990s miniaturizing components of the cardiopulmonary bypass circuit reduced priming volumes, producing less coagulation factor dilution and further improvement in patient outcome. During the past two decades, mortality after surgery for congenital cardiac disease has decreased dramatically and is now reported to be 4% in the European Association for Cardio-thoracic Surgery and the Society of Thoracic Surgeons Congenital Heart Surgery Database, the focus of clinical research and eff orts to improve quality has now shifted to that of the minimization of morbidity.

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