Perioperative management of adult patients with congenital heart disease undergoing neurosurgery

Abstract

Objective To review and analyze the perioperative anesthesia management of patients with adult congenital heart disease (ACHD) underwent neurosurgery, and to summarize the key points of perioperative anesthesia management for these patients, so as to achieve the goal of high clinical quality development. Methods This retrospective study analyzed the perioperative medical records of patients with ACHD underwent neurosurgery from January 2018 to December 2022. Demographic data, CHD types and complications, perioperative anesthesia management, postoperative complications and prognosis were analyzed. Results A total of 21 ACHD patients underwent neurosurgery were included in this analysis, 16 with atrial septal defect, 4 with ventricular septal defect, and 1 with single atrium and single ventricle accompanied with cyanosis and compensated hyper-hemoglobin. Left to right shunt was observed in 19 cases, and bidirectional shunt in 1 case. 11 cases were associated with heart chamber enlargement(right heart and left atrium). 20 cases received general anesthesia, and 1 case received nerve block regional anesthesia. six cases were persistently injected vasoactive drugs to maintain circulation stabilization. The intraoperative fluid balance was -6~+ 913 mL/h. The operation time was 46~355 min. 6 cases returned to ICU after surgery. 4 cases suffered central nervous system infection, 2 electrolytes disturbances, 2 coagulation abnormalities, 1 lower limb venous thrombosis, 1 abnormal liver function, and 1 death. The average length of hospitalization was (12.5±5.9) days. Conclusions Circulatory,cardiopulmonary function and fluid therapy are the key points of perioperative management of ACHD patients undergoing neurosurgery.

Keywords

• adult congenital heart disease|neurosurgery|perioperative period|anesthesia management|prognosis