Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.06.005
Brazilian Journal of Anesthesiology
Systematic Review

Anesthetic management of neonates undergoing diagnostic and therapeutic cardiac catheterization: a systematic literature review

Manejo anestésico de neonatos submetidos a cateterismo cardíaco diagnóstico e terapêutico: uma revisão sistemática da literatura

Lina M. Valencia-Arango, Angelica P. Fajardo-Escolar, Juan C. Segura-Salguero, Santiago Saenz-Quispe, Carolina Rincon-Restrepo, Adriana Posada, Vivian Ronderos, Ana H. Perea-Bello

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Abstract

Background
Several interventional cardiology procedures are required in neonates with congenital heart disease. Interventional cardiology procedures have a higher risk of cardiac arrest compared to other interventions. At present, there is great heterogeneity in the perioperative management of congenital heart disease neonates undergoing diagnostic cardiac catheterization or therapeutic cardiac catheterization.

Study objectives
Primary aim: Provide a systematic review of the most effective and/or safe anesthetic and perioperative management in neonates with congenital heart disease who undergo diagnostic cardiac catheterization or therapeutic cardiac catheterization. Secondary aim: Identify the medications, monitoring parameters and airway management used in the same population.

Design
Systematic literature review.

Setting
Catheterization laboratory.

Methods
Literature was searched (December 2017) in electronic databases Medline, EMBASE, ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database.

Main results
From 130 records identified, four studies met inclusion criteria and quality assessment. None of the studies were relevant to the primary objective. Regarding the secondary objectives, one study compared the efficacy and adverse effects of racemic ketamine and its S(+) ketamine enantiomer, one study reported the efficacy of subarachnoid anesthesia for high-risk children undergoing diagnostic cardiac catheterization, one study identified the factors associated to high severity adverse events related to sedation, anesthesia and airway, and one study retrospectively analyzed cardiac catheterization procedures in neonates weighing less than 2.5 kg.

Conclusion
There are no evidence-based recommendations available for congenital heart disease neonates undergoing cardiac catheterization. More studies are required to evaluate the ideal anesthetic and perioperative management in this population.

Keywords

Cardiac catheterization,  Newborn infant,  Premature infant,  Anesthesia,  Perioperative care,  Heart diseases

Resumo

Introdução
Vários procedimentos de cardiologia intervencionista são necessários em neonatos com doença cardíaca congênita. Os procedimentos de cardiologia intervencionista têm um risco maior de parada cardíaca em comparação com outras intervenções. Atualmente, há grande heterogeneidade no manejo perioperatório de neonatos com doença cardíaca congênita submetidos a cateterismo cardíaco diagnóstico ou cateterismo cardíaco terapêutico.

Objetivo
Objetivo principal: fornecer uma revisão sistemática do manejo anestésico e perioperatório mais efetivo e/ou seguro em neonatos com doença cardíaca congênita submetidos à cateterismo cardíaco diagnóstico ou cateterismo cardíaco terapêutico. Objetivo secundário: Identificar os medicamentos usados, parâmetros monitorizados e manejo das vias aéreas utilizado na população estudada.

Desenho
Revisão sistemática da literatura.

Local
Laboratório de hemodinâmica e cateterismo cardíaco.

Método
Foi realizada busca na literatura (Dezembro de 2017) nos seguintes bancos de dados eletrônicos: Medline, EMBASE, ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects e Health Technology Assessment Database.

Resultados principais
Dos 130 registros identificados, quatro estudos obedeceram aos critérios de inclusão e de avaliação de qualidade. Nenhum dos estudos foi relevante para o objetivo principal. Em relação aos objetivos secundários, um estudo comparou a eficácia e os efeitos adversos da cetamina racêmica e seu enantiômero S(+) cetamina, um estudo relatou a eficácia da anestesia subaracnóidea em crianças de alto risco submetidas ao cateterismo cardíaco diagnóstico, um estudo identificou os fatores associados à maior gravidade de eventos adversos relacionados à sedação, anestesia e vias aéreas, e um estudo analisou retrospectivamente os procedimentos de cateterismo cardíaco em neonatos com peso inferior a 2,5 kg.

Conclusão
Não há recomendações baseadas em evidências disponíveis para neonatos com doença cardíaca congênita submetidos a cateterismo cardíaco. Mais estudos são necessários para avaliar o manejo anestésico e perioperatório ideal nessa população.

Palavras-chave

Cateterismo cardíaco,  Recém-nascido,  Prematuro,  Anestesia,  Cuidados perioperatórios,  Doenças cardíacas

References

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