1. Incidence of Peri-anesthetic Adverse Events in Children with Congenital Cardiac Defects Undergoing Procedures in the Cardiac Catherization Laboratory Requiring Anesthesia. R.P. Moore M.D.; A. Kakavouli M.D.; M. Carson R.N.; S. Ohkawa M.D. ; L.S. Sun M.D. Columbia University Department of Anesthesiology New York, NY R.P. Moore M.D.; A. Kakavouli M.D.; M. Carson R.N.; S. Ohkawa M.D. ; L.S. Sun M.D. Columbia University Department of Anesthesiology New York, NY

2. Introduction  Inpatients with a history of congenital heart disease (CHD) are at increased risk for mortality following non-cardiac surgery (1).  Therefore, CHD patients are presumably at high risk for morbidity and mortality for all non-cardiac procedures (2).  This risk may be increased by the physiologic manipulations that occur in the cardiac catherization laboratory (Cath Lab)  This study quantifies the incidence of peri-anesthetic adverse events (AE) in CHD patients undergoing Cath Lab procedures requiring anesthesia care at our institution.  Inpatients with a history of congenital heart disease (CHD) are at increased risk for mortality following non-cardiac surgery (1).  Therefore, CHD patients are presumably at high risk for morbidity and mortality for all non-cardiac procedures (2).  This risk may be increased by the physiologic manipulations that occur in the cardiac catherization laboratory (Cath Lab)  This study quantifies the incidence of peri-anesthetic adverse events (AE) in CHD patients undergoing Cath Lab procedures requiring anesthesia care at our institution.

3. Methods  Following IRB approval, prospective data for all CHD patients undergoing Cath Lab procedures between August and October of 2008 were collected  Patients whose Cath lab procedures were in combination with direct surgical manipulation of the heart were excluded  Patients undergoing Electrophysologic or Pulmonary Hypertension studies were also excluded  Following IRB approval, prospective data for all CHD patients undergoing Cath Lab procedures between August and October of 2008 were collected  Patients whose Cath lab procedures were in combination with direct surgical manipulation of the heart were excluded  Patients undergoing Electrophysologic or Pulmonary Hypertension studies were also excluded

4. Methods  Data pertaining to demographics, biometrics, medical history, anesthesia care, procedure type, disposition, and outcome were collected.  Primary outcomes were Adverse Events (AE) as defined by institutional protocol and included death or end-organ dysfunction occurring within the first 72 postoperative hours.  Secondary outcomes were alterations in planned care.  Data were analyzed by unpaired t test or Chi-square as appropriate. P<0.05 was deemed significant.  Data pertaining to demographics, biometrics, medical history, anesthesia care, procedure type, disposition, and outcome were collected.  Primary outcomes were Adverse Events (AE) as defined by institutional protocol and included death or end-organ dysfunction occurring within the first 72 postoperative hours.  Secondary outcomes were alterations in planned care.  Data were analyzed by unpaired t test or Chi-square as appropriate. P<0.05 was deemed significant.

5. Results:  Data were collected for 88 CHD patients undergoing procedures in the Cath Lab that required anesthesia care  Data Were collected for patients with diverse diagnoses, biometrics, and disease burden  Data were collected for 88 CHD patients undergoing procedures in the Cath Lab that required anesthesia care  Data Were collected for patients with diverse diagnoses, biometrics, and disease burden

6. Results

7.  14/88 patients (15.9%) undergoing procedures in the CL requiring anesthesia care experienced AE  Institutional QA data reveals an AE rate of 4.2 % for all anesthetized patients.  Institutional QA data reveals an AE rate of 8.2 % for all CHD patients undergoing noncardiac procedures outside the Cath Lab  14/88 patients (15.9%) undergoing procedures in the CL requiring anesthesia care experienced AE  Institutional QA data reveals an AE rate of 4.2 % for all anesthetized patients.  Institutional QA data reveals an AE rate of 8.2 % for all CHD patients undergoing noncardiac procedures outside the Cath Lab

8. Results  9/16 Cath Lab Adverse Events Involved Cardiopulmonary disturbances  7 Patients (5 with cardiopulmonary AE required significant escalations of care  Escalations included: 1 day of mechanical ventilation; 1 ward and 4 ICU admissions  9/16 Cath Lab Adverse Events Involved Cardiopulmonary disturbances  7 Patients (5 with cardiopulmonary AE required significant escalations of care  Escalations included: 1 day of mechanical ventilation; 1 ward and 4 ICU admissions

9. Cardiopulmonary Adverse Events

10. Discussion  CHD patients with diverse diagnoses, demographics, and biometrics undergoing CL procedures experienced increased AE relative to CHD patients undergoing non-cardiac interventions outside the CL.  These Data Suggest that CHD patients undergoing Cath Lab Procedures with GA are at increased risk for AE particularly significant cardiopulmonary events.  The only feature distinguishing AE patients from the entire study population was longer duration of anesthesia. This may reflect an increased risk for AE in patients with anatomy requiring more complex manipulations or an effect of longer anesthesia.  CHD patients with diverse diagnoses, demographics, and biometrics undergoing CL procedures experienced increased AE relative to CHD patients undergoing non-cardiac interventions outside the CL.  These Data Suggest that CHD patients undergoing Cath Lab Procedures with GA are at increased risk for AE particularly significant cardiopulmonary events.  The only feature distinguishing AE patients from the entire study population was longer duration of anesthesia. This may reflect an increased risk for AE in patients with anatomy requiring more complex manipulations or an effect of longer anesthesia.

11. Discussion  Further Analysis are Planned with more data to confirm these findings  Understanding The causes for AE would allow for the development of strategies to improve patient care for CHD patients requiring GA in the Cath Lab and elsewhere.  Further Analysis are Planned with more data to confirm these findings  Understanding The causes for AE would allow for the development of strategies to improve patient care for CHD patients requiring GA in the Cath Lab and elsewhere.

12. References 1.Baum VC et al. Pediatrics 2000, 105 (2): 332-336 2. Sumpelmann R et al. Curr Opin Anesthesiol 2007, 20: 216-220.