General anesthesia for children with severe heart failure.

Severe heart failure in children is uncommon. The anesthetic management of children with this condition is challenging. The authors aimed to identify the frequency with which anesthesia for short noncardiac surgical procedures or investigations was complicated by life-threatening hemodynamic instability and to describe the anesthetic techniques used. This study retrospectively reviewed the anesthetic charts and notes of children admitted acutely with a diagnosis of severe heart failure (fractional shortening of 15% or less) who received general anesthesia for noncardiac surgical or diagnostic interventions during the 3-year period from September 2005 to September 2008. In this study, 21 children received a total of 28 general anesthetics. Two patients (10%) experienced a cardiac arrest, and both required unplanned admission to the authors' pediatric intensive care unit (PICU) postoperatively. A variety of anesthetic techniques was used. In 27 (96%) of the 28 cases, perioperative inotropic support was required. General anesthesia for children with severe heart failure is associated with a significant complication rate and should be administered by anesthetists familiar with managing all aspects of circulatory support for children in an appropriate setting.

Postal survey of training in pediatric cardiac anesthesia in the United Kingdom.

BACKGROUND: There are no nationally agreed standards for training in pediatric cardiac anesthesia despite the recommendation of two reports. Since then, anesthesia training has changed because of the introduction of competency-based training, the New Deal and the European Working Time Directive. METHODS: We surveyed consultant pediatric cardiac anesthetists to establish what training they had undergone and to compare this with what they would recommend for training in the specialty. We also wanted to determine the profession's views on establishing training guidelines and what areas of practice to include when setting standards. RESULTS: Seventy-three percent of consultants want the Royal College of Anaesthetists to set standards for training. The majority had spent at least 2 years training in general pediatric, adult cardiac and pediatric cardiac anesthesia as well as pediatric intensive care and had spent time gaining experience overseas. CONCLUSIONS: They would recommend the same experience for others but this is unlikely to happen within the current constraints of specialist registrar training. Therefore, further training in a fellowship program in the UK or abroad is likely to be necessary.