ABSTRACT
Despite significant improvements in overall outcome, neurological injury remains a feared complication following pediatric congenital heart surgery (CHS). Only if adverse events are detected early enough, can effective actions be initiated preventing potentially serious injury. The multifactorial etiology of neurological injury in CHS patients makes it unlikely that one single monitoring modality will be effective in capturing all possible threats. Improving current and developing new technologies and combining them according to the concept of multimodal monitoring may allow for early detection and possible intervention with the goal to further improve neurological outcome in children undergoing CHS.
Subject(s)
Cardiac Surgical Procedures/methods , Child , Child, Preschool , Electroencephalography , Heart Defects, Congenital/surgery , Humans , Infant , Infant, Newborn , Monitoring, Intraoperative/methods , Neurophysiological Monitoring/methods , Spectroscopy, Near-Infrared , Ultrasonography, Doppler, TranscranialSubject(s)
Brain/metabolism , Cardiopulmonary Bypass , Female , Humans , Male , Monitoring, Intraoperative , Oxygen/metabolismABSTRACT
Fast-tracking in cardiac surgery refers to the concept of early extubation, mobilization and hospital discharge in an effort to reduce costs and perioperative morbidity. With careful patient selection, fast-tracking can be performed in many patients undergoing surgery for congenital heart disease (CHD). In order to accomplish this safely, a multidisciplinary coordinated approach is necessary. This manuscript reviews currently used anesthetic techniques, patient selection, and available information about the safety and patient outcome associated with this approach.