Expert Consensus Statement Addresses Anesthesia Practices in Pediatric Congenital Cath Labs

November 11, 2016—The Society for Cardiovascular Angiography and Interventions (SCAI), the Society for Pediatric Anesthesia (SPA), and the Congenital Cardiac Anesthesia Society (CCAS) have recently published recommendations for institutions and physicians diagnosing and treating pediatric patients in the catheterization laboratory. 

An expert panel representing all three participating societies collaborated with the goal to provide practitioners and institutions performing these procedures with guidance consistent with national standards developed by The Joint Commission. The panel also aimed to provide clinicians and institutions with consensus-based recommendations and the supporting references to encourage their application in quality improvement programs.

The first-of-its-kind document, “SCAI/CCAS/SPA Expert Consensus Statement for Anesthesia and Sedation Practice: Recommendations for Patients Undergoing Diagnostic and Therapeutic Procedures in the Pediatric and Congenital Cardiac Catheterization Laboratory” is available online in SCAI’s Catheterization and Cardiovascular Interventions. The writing committee for the document was led by co-chairs Kirsten C. Odegard, MD, and Robert Vincent, MD.

According to SCAI, studies concerning anesthesia-related morbidity and mortality have demonstrated that pediatric patients, especially patients with congenital heart disease, are at increased risk for adverse events and even cardiac arrest during surgery. Common complications in children undergoing anesthesia include airway events (eg, laryngospasm, bronchospasm, apnea, and aspiration), cardiovascular events (eg, hypotension, arrhythmias, and cardiac arrest), and postoperative issues.

The consensus statement provides pre-, intra-, and postprocedure recommendations for patient monitoring in the pediatric congenital cardiac catheterization laboratory (PCCCL), regardless of whether minimal or no sedation is being used, or general anesthesia is being provided by an anesthesiologist. 

As summarized by SCAI, the document includes:

• Anesthesia risks in patients with cardiac disease undergoing procedures in the PCCCL.
• Specific cardiac defects with increased anesthetic risks.
• Catheterization and procedural risks in the catheterization laboratory.
• Volume management in patients undergoing catheterization procedures.
• Level of cardiology and anesthesia expertise appropriate for the PCCCL.

In the SCAI announcement, Dr. Vincent commented, “Practices regarding the way sedation is administered is highly variable across United States hospital systems and institutions. We developed these recommendations to alert and educate physicians and hospital administrators to the complex and dynamic challenges they may face when treating pediatric patients with congenital heart disease.” Dr. Vincent, a fellow of SCAI, is a pediatric cardiologist at Children’s Healthcare of Atlanta in Atlanta, Georgia.