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Management of the high risk paediatric cardiac patient for investigation under general anaesthesia

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Definition of High Risk

  1. Patients known to be at high risk for general anaesthesia due to their underlying cardiac condition. This includes but is not limited to:
    1. Williams syndrome and all supravalvular aortic stenosis
    2. Single ventricle patients both pre and post stage 1 repair
    3. Cardiomyopathy / Myocarditis
    4. Pulmonary Hypertension from whatever aetiology
    5. Patients with severe ventricular hypertrophy
    6. Patients with significant left or right ventricular dysfunction
    7. Patients with critical left or right ventricular outflow tract obstruction
  2. All Acute patients
  3. All PICU and NICU patients.
  4. Patients with a condition known to be associated with anaesthesia issues.
    For example: Any airway problem, previous anaesthesia problems

Management

All patients meeting ANY of the above criteria need to be discussed at the soonest opportunity.The discussion is to be between the requesting  consultant cardiologist and a paediatric cardiac anaesthetist. The discussion needs to involve the imaging consultant performing the examination.

The point of contact for the cardiologist will be the Starship anaesthetic co-ordinator (021 334 344). They will put the cardiologist in touch with a paediatric cardiac anaesthetist.

A plan will be formulated as to whether the procedure can be safely performed, how the procedure will be carried out, and where the patient will go post procedure. The possible outcomes are:

  • Patient to PACU and then to Ward 23B - IOA or bed
  • Patient to PACU and then PICU
  • Directly back to either PICU or NICU and anaesthetist will decide where patient will be extubated.

It is the responsibility of the booking cardiology team to ensure there is a PICU bed available should it be required.

NOTE: There will be patients identified by the anaesthetist as high risk because of non-cardiac issues. It is the responsibility of the anaesthetist to discuss these patients with the consultant paediatric cardiologist who is managing the patient.

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Document Control

  • Date last published: 01 October 2018
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Cardiology
  • Author(s): John Stirling
  • Owner: John Stirling
  • Editor: Marion Hamer
  • Review frequency: 2 years