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TitleAnesthesia for Congenital Heart Disease, Second Edition
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Table of Contents
                            Anesthesia for
Congenital Heart Disease
	List of Contributors
	Part 1: History, Education, Outcomes, and Science
		Chapter 1: History of Anesthesia for Congenital Heart Disease
		Chapter 2: Education for Anesthesia in Patients with Congenital Cardiac Disease
		Chapter 3: Quality, Outcomes, and Databases in Congenital Cardiac Anesthesia
		Chapter 4: Embryology, Development, and Nomenclature of Congenital Heart Disease
		Chapter 5: Physiology and Molecular Biology of the Developing Circulation
		Chapter 6: Anesthetic Agents and Their Cardiovascular Effects
		Chapter 7: Cardiopulmonary Bypass
		Chapter 8: The Inflammatory Response and Its Modification
	Part 2: Monitoring
		Chapter 9: Vascular Access and Monitoring
		Chapter 10: Neurologic Monitoring and Outcome
		Chapter 11: Transesophageal Echocardiography Congenital Heart Disease
		Chapter 12: Bleeding and Coagulation: Monitoring and Management
	Part 3: Preoperative Considerations
		Chapter 13: Preoperative Evaluation and Preparation
		Chapter 14: Approach to the Fetus, Premature, and Full-Term Infant
		Chapter 15: Approach to the Teenaged and Adult Patient
	Part 4: Management,
		Chapter 16: Hemodynamic Management
		Chapter 17: Arrhythmias: Diagnosis and Management
		Chapter 18: Airway and Ventilatory Management
		Chapter 19: Regional Anesthesia and Postoperative Pain Management
	Part 5: Anesthesia for Specific Lesions
		Chapter 20: Anesthesia for Left-to-Right Shunt Lesions
		Chapter 21: Anesthesia for Left-Sided Obstructive Lesions
		Chapter 22: Anesthesia for Right-Sided Obstructive Lesions
		Chapter 23: Anesthesia for Transposition of the Great Vessels
		Chapter 24: Anesthesia for the Patient with a Single Ventricle
		Chapter 25: Anesthesia for Miscellaneous Cardiac Lesions
		Chapter 26: Anesthesia for Cardiac and Pulmonary Transplantation
	Part 6: Anesthesia Outside the Cardiac Operating Room
		Chapter 27: Anesthesia for the Cardiac Catheterization Laboratory
		Chapter 28: Anesthesia for Noncardiac Surgery and Magnetic Resonance Imaging
		Chapter 29: Cardiac Intensive Care
		Chapter 30: Mechanical Support of the Circulation
	Appendix : Texas Children’s Hospital Pediatric Cardiovascular Anesthesia Drug Sheet (March 2009)
	Color Plates
Document Text Contents
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CHAPTER 16 Hemodynamic management

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PART 4 Management

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torsade de pointes, 323
total anomalous pulmonary venous return

(TAPVR), 388–91. See also left-to-right shunt
lesions; partial anomalous pulmonary
venous return (PAPVR)

anatomy, 388–90
anesthetic considerations, 391
anesthetic management, 392
pathophysiology/natural history, 390
postbypass echocardiographic data, 195t
surgical approaches, 390–91
types of, 388–90

tracheostomy, 6
tranexamic acid, 105, 106, 213
transcranial Doppler ultrasound, 173–4
transcutaneous external pacing, 334
transesophageal echocardiography (TEE), 183–98

in catheterization laboratory, 195–6
complications, 196–7
contraindications, 196
endocarditis prophylaxis, 197
equipment, 186
evaluation of congenital heart defects by, 191–3

assessment of pressure gradients, 193
assessment of ventricular filling/function, 193
preoperative evaluation, 191–3

history of, 184
imaging planes, 188–90

longitudinal plane examination, 189–90
multiplane examination, 189–90
transverse plane examination, 189

indications for, 185–6
influences on anesthetic/surgical management,

influences on clinical outcomes, 195
limitations of, 197–8
multiplane imaging, 184, 185f
and orotracheal intubation, 340
overview, 183
in positioning of central venous catheters, 147–8
probes, 186–91

insertion, 187–8
manipulation, 188–91
selection, 186–7

quality assurance, 198
role in VAD insertion, 620–21
sequential segmental analysis, 190–91
teaching/learning, 18
training/certification, 197–8
transgastric examination, 190

transgastric examination, 190
transitional atrioventricular canal, 382
transitional circulation, 46, 56f
transposition of great arteries (d-TGA), 444–50. See

also right-sided obstructive lesions
anatomy, 444–6
anesthetic considerations, 448–50
anesthetic management of, 452, 567–8
coronary artery anatomy, 445–6
with intact ventricular septum, 445
with left ventricular outflow tract obstruction,

options for surgical correction, 447–8
pathophysiology/natural history of, 446–7

prebypass echocardiographic data, 192t
preoperative evaluation, 270–71
terminology, 225
with ventricular septal defect, 445

transpulmonary thermodilution cardiac output,

transthoracic catheters, 146–7
transverse plane examination, 189
tribromethanol, 4
tricuspid atresia, anatomical features of, 457f
tricuspid valve, Ebstein’s malformation of, 47
triiodothyronine, 67, 248–9
troponin C, 58
troponin I, 58
troponin T, 58
truncus arteriosus, 386–8

anatomy, 386–7
anesthetic considerations, 387–8
anesthetic management, 392, 564
development of, 47
partitioning of bulbus cordis and, 43
pathophysiology/natural history, 387
postbypass echocardiographic data, 195t
prebypass echocardiographic data, 193t
preoperative evaluation, 276
types of, 386–7

tubing, 96–7
tumor necrosis factor-alpha (TNF-α), 123, 126
tunneled Broviac type percutaneous/intracardiac

lines, 147–9
Turner syndrome, 552t

ulnar artery, 153
ultrafiltration, 103–4

in cardiopulmonary bypass circuit, 96
conventional, 103–4, 130, 249
modified, 103–4, 130, 249
zero-balance ultrafiltration, 249

ultrasound, 155–6
umbilical arteries, 43–4, 152
umbilical veins, 41, 142–3
umbilical venous catheters (UVCs), 143
Univent tube, 345

valvotomy, 531
vancomycin, 549
vascular access and monitoring, 141–62

arterial access, 150–3
arterial cutdown, 153
axillary artery, 152
brachial artery, 152
dorsalis pedis artery, 153
femoral artery, 150–51
posterior tibial artery, 153
radial artery, 150
temporal artery, 152
ulnar artery, 153
umbilical artery, 152

complications, 159–62
arrhythmias, 162
infection, 161–2
malposition, 160–61
perforation, 160–61
pneumothorax, 161

systemic air embolus, 162
thrombosis, 159–60

percutaneous pulmonary artery catheterization,

ultrasound guidance, 155–6
venous access, 149–50

continuous SVC oxygen monitoring, 147
correct placement of central venous catheters,

direct transthoracic intracardiac vascular

access, 146–7
percutaneous central venous access,

percutaneously inserted central catheters,

peripheral veins, 141–2
tunneled Broviac type

percutaneous/intracardiac lines, 147
umbilical veins, 142–3

vascular monitoring, 156–9
cardiac output monitoring, 158–9
central venous oxygen saturation monitoring,

central venous waveforms, 158
intravascular pressure waveforms, 156–8
left atrial waveforms, 158
right atrial waveforms, 158

vascular rings, 480–82
anatomy, 480–81
anesthetic considerations/approaches, 482
management of, 489
pain control, 482
partial, 481
pathophysiology/natural history of, 481
postoperative airway management, 482
surgical approaches, 481–2

vascular tone, regulation of, 67
vasoactive drugs, 292t
vasoconstrictors, 296–7

norepinephrine, 296
phenylephrine, 296–7
vasopressin, 297

vasodilators, 297–300
inhaled nitric oxide, 299–300
nitroglycerin, 297
phenoxybenzamine, 300
phentolamine, 300
prostaglandins, 298–9
sildenafil, 299
sodium nitroprusside, 297–8

VATER association, 552t
vecuronium, 81, 89, 607
velocardiofacial syndrome, 228
venous access, 141–50. See also arterial access;

vascular access and monitoring
continuous SVC oxygen monitoring, 147
correct placement of central venous catheters,

direct transthoracic intracardiac vascular access,

percutaneous central venous access, 143–6
percutaneously inserted central catheters,

peripheral veins, 141–2


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venous access (Contd.)
tunneled Broviac type

percutaneous/intracardiac lines, 147
umbilical veins, 142–3

venous system, defects of, 49
ventilation/perfusion (V/Q) matching, 343
ventricular arrhythmias. See also arrhythmias
ventricular assist devices (VADs),

Abiomed BVS 5000, 618
anesthesia/sedation/analgesia for insertion,

anticoagulation, 623
antifibrinolytic therapy, 623
Berlin Heart VAD, 618
centrifugal pumps, 616–17
EXCOR, 618
HeartMate II, 619
MEDOS HIA-VAD system, 618
MicroMed DeBakey VAD Child, 619–20
outcome/complications, 624
in pediatric patients, 599

platelet aggregation therapies, 623
Tandem Heart, 617–18
Thoratec VAD, 618–19
weaning from, 622
weaning from cardiopulmonary bypass to,

ventricular fibrillation, 326
ventricular inversion, 268
ventricular looping, 51
ventricular segment, 51
ventricular septal defect (VSD), 379–81, 436–9.

See also atrial septal defect (ASD);
left-to-right shunt lesions; right-sided
obstructive lesions

algorithm for decision-making, 437–9
anatomy, 436
anesthetic considerations, 381
anesthetic management, 392, 563
closure of, 534–5
development of, 43
pathophysiology/natural history of,

380, 436

perioperative anesthetic management,

prebypass echocardiographic data, 192t
surgical approaches, 380–81, 436–7
in teenaged/adult patients, 267
transcatheter closure, 381
transposition of great arteries with, 445
types of, 380

ventricular septation, 43
ventricular tachycardia (VT), 322–3
verapamil, 328t, 329
video-assisted thoracoscopic surgery (VATS), 344
vitelline arteries, 43–4
vitelline veins, 41
volatile agents, 77–80

warm cardiopulmonary bypass, 108–9
weave network, 58
Williams syndrome, 552t
Wolf-Parkinson-White syndrome, 320

zero-balance ultrafiltration, 249


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