In UHS we perform between 300-400 paediatric cardiac cases per year. During your attachment you may well have the opportunity to join the congenital team in theatre B. Dr Andy Curry is the lead for congenital anaesthesia in UHS and the team also consists of a number of other consultant paediatric cardiac anaesthetists: Dr Gareth Charlton, Dr Mike Herbertson, Dr Jonathan Huber, Dr James Montague, Dr Tom Pierce & Dr Kirstin Wilkinson all undertake these lists.
We perform complex congenital surgery with the full back up of the PICU/surgical/perfusionist ECMO team. The majority of these cases have great outcomes and overall the survival in UHS and the UK is excellent. Full details of UHS outcome data is open resource material and found here. It is worth reading to understand the effort & quality being delivered in your home centre. We also undertake some incredibly high risk cases and our communication and professionalism with the parents of these children needs to be of the highest order.
This section mean to explain some of the basic set up of a paediatric cardiac case in UHS so you might understand the stages specific to a baby having heart surgery.
All patients are pre assessed the day before heart surgery. They are brought into E1 ward and the nursing team there are very organised and helpful at getting everything ready for the assessing anaesthetist. We use the normal pink anaesthetic card but note that children won’t necessarily have the same pre-op investigations: PFTs and angiograms are often unnecessary as these assess acquired diseases.
The majority of paediatric cardiac surgery is for babies. Most children have an IV sited by the E1 team allowing for IV induction, sometime an inhalational induction is mandatory however and this should be discussed with the parents. Most consultants are happy for parents to accompany their child to the anaesthetic room however it should be noted that in children < 6m age there is no separation anxiety for the child – it is for the parents benefit. As such, some parents when distressed choose not to come into the AR.
Monitoring is established via ECG and Massimo pulse oximetry, BP can be measured with NIBP. An IV induction is usual. There are many ways to skin a cat but most of us now favour a balanced anaesthetic using moderate doses of fentanyl (2mcg/kg) and midazolam (0.2mg/kg) and a NDMR. Other agents such as propofol and thiopentone clearly work and it mostl
Southampton Cardiac Anaesthesia 