**Invasive pressure monitoring**

60 Perioperative Considerations in Cardiac Surgery

Electrolyte abnormalities are commonly seen in patients who receive diuretics and parental

ECG may show ventricular strain or hypertrophy pattern. Echocardiography is used for doppler and color flow mapping while catheterization is used for information about pressures in different chambers, magnitude of shunt and coronary anatomy. Examine chest X-Ray for heart position (Dextrocardia) and size, atelectasis, acute respiratory infection, vascular markings and elevated hemidiaphragm. High pulmonary flow will leads to

Neurological assessment and MRI12 may also be needed in these patients. Delayed brain development is associated with certain CHD. Fetal MRI can help in early assessment of

Presence of CHD in paediatric patients poses a great challenge for anaesthetist13 as morbidity and mortality is quite high. Incidence of cardiac arrest in these paediatric patients under anaesthesia is higher14 than non CHD patients and mainly due to pharmacological

Intravenous line must be placed in all patients even for minor procedure. All intravenous tubings should be free of air bubble. Polycythaemic patient must be well hydrated before

Sevoflurane15 is preferred over halothane due to better haemodynamic stability in CHD patients. Most of the CHD patients tolerate inhalation induction with sevoflurane while patients with poor cardiac function, may not tolerate inhalation induction. Ionotropes

Monitoring in paediatric CHD is the same as in adult cardiac surgery but there are few differences and considerations during surgery. Monitoring during surgery ranges from simple ECG to blood glucose, which is controversial due to non availability of evidence that

Although ECG can be helpful in the detection of ST changes but is mainly used for arrhythmia detection in paediatric patients. Even arrhythmia detection is difficult due to baseline tachycardia. Skin should be prepared for electrode by rubbing with alcohol pad or swab. Three leads system is commonly used while in older children five leads system can

Non invasive blood pressure should always be monitored even in the presence of arterial line. Cuff should be 20% wider than the diameter of limb where non invasive blood pressure is monitored. Smaller cuff results in erroneously high pressure while larger cuff will give

nutrition. Hypocalcaemia commonly found in patients with Di George syndrome.

increased pulmonary marking while reduced flow causes oligaemic lung fields.

immature brain.

**5.1 Monitoring** 

also be used.

lower pressures.

**5.1.1 Electrocardiogram** 

**Non invasive monitoring** 

**5.1.2 Blood pressure monitoring** 

**5. Intraoperative considerations** 

interaction and over dose5.

induction either by IV or orally.

should be continued if patient is on ionotropes.

tight blood sugar control improves outcome16.

It not only provides beat to beat continuous blood pressure monitoring but also provides easy access for blood sampling. Pressure monitoring tubing and stopcocks should be free of air to prevent air embolism and damping of system. It is also a major source of fluid overload as system continuously flushes 2-4 ml/hr per invasive line. In addition a quick flush also pushes about 1-2 ml of fluid per second . Dextrose can be used but usually normal saline is the flushing solution as bacterial growth is less likely.
