Stensrud, Paul E.

Abstract Introduction: Historically, children undergoing cardiac catheterization have been managed with general endotracheal anesthesia (GETA). However, recent practice has favored general anesthesia with total intravenous anesthesia (TIVA). This study compares procedural outcomes in the pediatric cardiac catheterization laboratory (PCCL) for children undergoing low-risk cardiac catheterization with GETA vs. TIVA. Methods: We reviewed all patients aged 1–12 years, who underwent outpatient diagnostic or simple interventional catheterization from January 2016 – September 2023. Patients were divided into cohorts by type of anesthesia (GETA vs. TIVA). The primary outcome measure was total patient time in the PCCL (“door-to-door” time). Secondary outcomes were procedure duration (“sheath time”), length of hospital stay, and the major adverse event (MAE) rate. Results: A total of 401 patients were included. Of these patients, 226 underwent GETA and 175 underwent TIVA. There were 148 interventional procedures and 72 patients had single-ventricle physiology. There was no significant difference between the two cohorts in terms of demographic factors such as age, weight, procedure indication and physiological complexity as well as outcomes such as sheath time, hospital stay and MAE. However, the average door-to-door time of the TIVA cohort was 25 minutes shorter than the GETA cohort (p < 0.001). Conclusions: In this single center, retrospective study of anesthesia management for children undergoing low-risk cardiac catheterization, TIVA is associated with significantly shorter door-to-door time in the PCCL without an increase in procedure duration, hospital stay, or rate of complications. These findings have potential clinical significance supporting increased use of TIVA during pediatric cardiac catheterization.

Provision of anesthesia care to patients undergoing thoracoscopic procedures, especially video-assisted thoracoscopy, requires thorough knowledge of the sur gical procedure and the physiology of one-lung ventila tion, as well as meticulous attention to detail by the anesthesia personnel caring for these patients. Thoracos copy is used increasingly to perform almost the entire range of thoracic surgical procedures in a minimally invasive fashion. Excellent quality anesthetic care is necessary to assure the benefits of minimally invasive surgery to the maximum number of patients undergo ing thoracic surgery. This article will provide anesthesi ologists caring for patients undergoing thoracoscopy with the necessary working knowledge of the technical aspects of the procedure and understanding of the relevant anesthetic implications. Preoperative, intraop erative, and postoperative concerns will be addressed. The scope of this article will be limited to noncardiac uses of thoracoscopy.