Anesthetic management of low birth weight infants undergoing surgery for congenital heart disease without cardiopulmonary bypass

ZENG Linling; WANG Sheng; HE Shaoru; LIANG Jiexian; ZHANG Yongqin

doi:10.3969/j.issn.1673-4254.2013.12.21

Abstract：Objective To summarize anesthetic management of low birth weight infants undergoing surgical intervention of congenital heart disease without cardiopulmonary bypass. Methods Fifty-three low birth weight infants (including 49 premature infants) with congenital heart disease underwent surgical treatment without cardiopulmonary bypass during the period from June, 2003 to July, 2013. The mean gestational age of the infants was 30.96±3.09 weeks (26-40 weeks) with a mean age on the operation day of 32.81 ± 20.76 days (4-87 days), birth weight of 1429.90 ± 455.08 g (640-2460 g), and weight on the operation day of 1750.20±481.59 g (650-2460 g). All the infants underwent cardiac operations without cardiopulmonary bypass under general anesthesia. The respiratory parameters and acid-base and electrolyte balance were adjusted according to blood gas analysis. The inotropic drug was used to maintain the hemodynamic stability. Results Forty-seven of the infants received patent ductus arteriosus (PDA) ligation. Of these infants, 1 had cardiac arrest before the operation with failed cardiopulmonary resuscitation, and in another case, PDA ligation was aborted due to severe hypoplasia of the aortic valve and ascending aorta found intraoperatively by transesophageal echocardiography. Two infants underwent coarctation of the aorta (CoA), and 1 of them died during the operation due to cardiac arrest. The total mortality of these infants was 3.77%and the early postoperative mortality (<72 h) was 5.66%. Conclusion Non-cardiopulmonary bypass surgery can be performed in low birth weight infants in early stage, and effective anesthetic management can reduce the perioperative mortality and improve the postoperative survival rate.