[Anesthesia for the newborn submitted to cardiac surgery with cardiopulmonary bypass.].

BACKGROUND AND

OBJECTIVES

Congenital heart diseases affect 0.8% of liveborn infants and many need neonatal surgical correction. Cardiac surgery with cardiopulmonary bypass (CPB) in this age is associated to higher risk of complications related to child's functional immaturity, lack of CPB equipment fully compatible with neonate (NN) size and technical difficulties to correct cardiac defects. This article aimed at describing aspects related to anesthetic technique, CPB and their effects on NN.

CONTENTS: High fentanyl or sufentanil doses promote adequate anesthesia without interfering with cardiocirculatory stability. Opioids residual respiratory depression is not a problem for these patients because most of them will need immediate postoperative respiratory assistance. CPB may be followed by heart manipulation-induced hypotension and/or bleeding. Inadequate venous and aortic cannula position may lead to severe complications, such as insufficient brain flow or difficult venous drainage. Deep hypothermia and total circulatory arrest are common during CPB. Hypothermia changes blood viscosity, which is treated with hemodilution and has implications on pH correction (alpha-stat versus pH stat). Low cardiac output is common during CPB weaning and adjustments in one or all its components (preload, contractility, afterload and heart rate) may be necessary. In addition to classic drugs, such as epinephrine and dopamine, other substances may be needed, such as aprotinin, nitric oxide or phosphodiesterase inhibitors.

CONCLUSIONS

Anesthesiologists play a major role in adjusting perioperative homeostasis. Understanding the type of cardiac disease, the correction to be performed and body response to CPB may be useful for the management of those children.