Anesthesia for Arterial Switch Operation in Simple Transposition of the Great Arteries : Experience at Siriraj Hospital

UNGKAB PRAKANRATTANA, M.D .* , SOMCHAI SRIYOSCHATI, M.D .** , SIRILAK SUKSOMPONG, M.D .* , SAMPHANT PORNVILAWAN, M.D .**

Affiliation : * Department of Anesthesiology, ** Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University. Bangkok 10700, Thailand.

AbstractAnesthetic management of cardiac patients with complete transposition of the great arteries (TGA) undergoing arterial switch operation (ASO) is challenging. The anesthetic course and peri- operative problems were studied. A prospective data collection study of 87 patients was performed between January 1991 and February 2002. The patients were divided into 3 groups : Group 1; 27 neo- nates with TGA with an intact ventricular septum (IVS), Group 2; 21 with TGA, with IVS who under- went two-stage ASO, and Group 3; 39 with TGA, with a large VSD. The anesthesia consisted of low- dose fentanyl, thiopental, atracurium and isoflurane. Monitoring included ECG, radial or femoral arterial pressure, CVP, LAP, core temperature, SpO2, P CO2, urine output, ABG's, Hct, ACT, serum glucose and potassium. Fortunately the courses of anesthesia were uneventful. Usual vasoactive medication administered following CPB included nitroglycerin, dobutamine and dopamine.
Groups 1, 2 and 3 contained 18.5 per cent, 14.3 per cent and 33.3 per cent of patients who required adrenaline respectively. And only 7.7 per cent of patients in Group 3 had milrinone as an inotrope. Early tracheal extubation, 2 hours after admission to ICU was performed in 3 patients.
Perioperative complications included bleeding, low cardiac output, diaphragmatic paresis, digitalis intoxication, metabolic alkalosis, convulsion, pulmonary hypertensive crisis and death. Two patients who developed a pulmonary hypertensive crisis were successfully managed with inhaled nitric oxide. The overall hospital mortality rate was 19.54 per cent. In conclusion, the anesthetic management for ASO in 87 simple dTGA patients was uneventful at Siriraj Hospital. The major perioperative mor- bidity and hospital mortality were not directly anesthetic contribution.

Keywords : Arterial Switch Operation, Transposition of the Great Arteries, Anesthesia in Congenital Heart Disease

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