Theatre B is the home of childrens heart surgery in Southampton. Drs Curry, Wilkinson, Al-Azzawi, Montague, Huber, Wessels & Bakalova all undertake these lists.
Congenital cardiac surgery is a complex and fascinating subspecialty that can sometimes be intimidating to residents and fellows, but we have all the exposure and facilities in Southampton to train people to undertake this endlessly challenging and rewarding discipline.
In the OR most cases have some emergency medications drawn up. As most of our patients are babies we do not index emergency meds by weight but rather use a ‘one size fits all’ approach. For any sick cardiac baby the following is appropriate: 1ml of atropine (blue needle attached), 1ml of sux (blue needle attached), 5 mls of calcium gluconate, 10 mls of 10 mcg/ml adrenaline (this is made with 1 ml of a minijet 1:10,000 diluted with 9 mls 0.9% NaCl, 10 mls of 1 mcg/ml adrenaline (this is made by taking one ml of the 10 mcg/ml syringe and diluting it with a further 9 mls of 0.9% NaCl.
Heparin at a slightly augmented dose of 400 IU/kg is prepared (due to lower average levels of antithrombin 3), an ACT syringe and ABG are all prepared in OR as usual.
Most consultants will vary with precise medications used but as a guide:
- Fentanyl: 20 mcg/kg
- Midazolam: 200 – 400 mcg/kg
- Sometimes propofol 2-3 mg/kg
- NDMR (such as vecuronium 0.1-0.2mg/kg, pancuronium 0.2mg/kg, or rocuronium 1 mg/kg)
- Cefuroxime: 30 mg/kg (2 doses)
- Tranexamic acid: 30 mg/kg
If aprotinin is used it is usually for complex multi-redo sternotomies or predicted extremely long CPB runs at a dose of 30,000 U/kg bolus then 30,000 U/kg to the pump then 10,000 U/kg/hr until CPB discontinues.
phenylephrine 100mcg/ml in 10 mls for the perfusionist.
[Phenylephrine is rarely drawn up routinely for paeds cardiac]
Blood products:
Currently all paediatric patients presenting for heart surgery have a “hypo pack” prepared for them. This consists of RBC for transfusion and a bag of appropriate platelets (approx 250 mls) on the rocker. If any blood products are required we call extension 4620 1 hour in advance and request verbally for products to be prepared. If clotting factors are required < 1 year then octaplas is used, if > 1 year FFP or PCC (currently prothromplex) as an alternative/adjunct.
If the patient requires inotropes then the B agonist of choice is dopamine. The preparation schedule is on the cupboard in theatre B. Dopamine 15mg/kg is drawn up from the 40mg/ml ampoule and mixed with 5% dextrose to make 50 mls. 1 ml/hr of this mix = 5 mcg/kg/hr
MIlrinone is a frequently used inotropes in paediatrics and is drawn up as 10mg (=10mls) and diluted with 40 mls of 5% dextrose to make 50 mls. For most babies a dose range of 0.25-0.5 mcg/kg/min is appropriate
If needed our techs can arrange inhaled nitric oxide (iNO) on bleep 2317. They will help connect to the theatre breathing circuit and we usually will start at a dose of 20ppm.
Prior to transferring to PICU at the end of the case the case must be ended on metavision and the patient assigned to the correct clinical area on the check out screen and PICU called on 6972 to make sure everything is ready prior to departure.
Southampton Cardiac Anaesthesia 