Title Anesthesia in patients with congenital heart defects Title (croatian) Anestezija u bolesnika s prirođenim srčanim greškama Author William Anthonius Allan Migo Mentor Vilena Vrbanović Mijatović (mentor)Committee member Vilena Vrbanović Mijatović (predsjednik povjerenstva)Committee member Daniela Bandić Pavlović (član povjerenstva)Committee member Dinko Tonković (član povjerenstva)Granter University of Zagreb Defense date and country 2023-07-13, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Congenital Heart Disease (CHD) is the most common birth defects in humans affecting ~1% of live births worldwide. CHDs are structural abnormalities of the heart arising during fetal development leading to abnormal shunt formation and circulation of the pulmonary and systemic circulations. The exact causes of CHDs are not well understood, but a combination of genetic and environmental factors are thought to play a role. CHDs can range from simple defects that may not require treatment, to complex defects that can be life-threatening and require immediate surgical intervention.
Over recent decades, surgical and medical intervention has lead to >90% of children with CHD to reach adulthood defining a new population of adults with CHD (ACHD) previously known as Grown up CHD (GUCHD).
The anaesthetic management of adults with CHDs (ACHDs) presents a unique set of challenges for anaesthesiologists. The goal of anaesthetic management in CHD patients is to provide safe and effective anaesthesia while minimizing the risks associated with the patient's underlying cardiac defect. This requires knowledge of the patient's anatomy, physiology, and other specifics of their cardiac defect. Importantly, a multidisciplinary approach involving primary care physicians, cardiologists, cardiac surgeons, and anaesthesiologists with ACHD expertise is advised. These patients are at increased risk of morbidity and mortality with abnormal shunting and chronic hypoxemia. This leads to long term physiological changes and complications including haemodynamic instability, congestive heart failure (CHF), pulmonary hypertension (PH), dysrhythmias, threat of cyanotic spells, acid-base imbalances, coagulation defects, abscess induced seizures, meningitis and more.
Congenital Heart Disease; Anaesthesia; ManagementThis thesis explores recent developments in anesthetic management of patients with CHDs during non-cardiac surgery. As there is a growing ACHD population, anesthesiologists should be aware of their complex physiologies and subsequent anesthetic management as they encounter them during their clinical practice. This includes knowledge of their anatomy, physiology, and inherent CHD risk. During anaesthetic management they should carry out extensive medical histories and perioperative risk assessment.
Abstract (croatian) Kongenitalne srčane bolesti (CHD) su najčešće prirođene, pogađaju otprilike 1% novorođene djece diljem svijeta. CHD-ovi su strukturne abnormalnosti srca koje nastaju tijekom razvoja fetusa, rezultirajući abnormalnim preusmjeravanjem i cirkulacijom između plućne i sistemskih cirkulacija. Točni uzroci CHD-a nisu dobro istrazeni, ali smatra se da kombinacija genetskih i okolišnih čimbenika igra ulogu. CHD-ovi mogu varirati od jednostavnih mana koje možda ne zahtijevaju liječenje do složenih mana koje mogu biti opasne po život i zahtijevaju hitnu kiruršku intervenciju.
Tijekom posljednjih nekoliko desetljeća, kirurški i medicinski zahvati postigli su da preko 90% djece s CHD-om dostiglo odraslu dob, stvarajući novu populaciju odraslih osoba s CHD-om (ACHD), ranije poznatu kao Grown-Ups with Congenital Heart Disease (GUCHD).
Anestezijsko liječenje odraslih osoba s CHD-om (ACHD) predstavlja jedinstvene izazove za anesteziologe. Cilj anestezijskog upravljanja kod pacijenata s CHD-om je pružiti sigurnu i učinkovitu anesteziju uz minimiziranje rizika povezanih s osnovnom srčanom manom pacijenta. To zahtijeva razumijevanje anatomije, fiziologije i drugih specifičnosti pacijentove srčane mane. Važno je napomenuti da se savjetuje multidisciplinarni pristup koji uključuje liječnike primarne zdravstvene zaštite, kardiologe, srčane kirurge i anesteziologe s stručnim znanjem o ACHD-u. Ti pacijenti imaju povećani rizik od morbiditeta i smrtnosti zbog abnormalnog manevriranja i kronične hipoksemije. To dovodi do dugoročnih fizioloških promjena i komplikacija, uključujući nestabilnost hemodinamike, zatajenje srca (CHF), plućnu hipertenziju (PH), poremećaje srčanog ritma, cijanotske epizode, poremećaje kiselinsko-bazne ravnoteže, poremećaje zgrušavanja, napadaje izazvane apscesom, meningitis i još mnogo toga.
Ovaj rad istražuje najnovija postignuća u anestezijskom liječenju pacijenata s CHD-om tijekom nekardioloških zahvata.
Keywords
Congenital Heart Disease
Anaesthesia
Management
Keywords (croatian)
kongenitalne srčane bolesti
anestezia
upravljanje
Language english URN:NBN urn:nbn:hr:105:285368 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-09-01 11:32:42
