Our Summary

This research paper is about a survey sent to members of the Congenital Cardiac Anesthesia Society (CCAS) to understand how much and in what ways they use a method known as tissue oximetry in pediatric cardiac surgery. Tissue oximetry is a technique that measures the amount of oxygen in tissues, which is important for understanding how well the heart is working.

Out of the 1,131 members, 185 completed the survey. The results showed that most of the respondents (93.5%) use tissue oximetry. It is mostly used during cardiac surgery with a technique called cardiopulmonary bypass, but also used in cardiac surgeries without this technique, in the cardiac catheterization laboratory, and for other major non-cardiac surgeries.

However, only 14.5% of respondents said their institution has a specific protocol or guidelines for using this method. The most common way to use the oximetry sensor was on both sides of the brain. More than 90% of respondents said they have changed their clinical management based on the results from tissue oximetry, but there was a difference in when they would make these changes.

Most respondents agreed that tissue oximetry is a helpful additional tool to standard monitors during surgery, as it confirms what they observe clinically and helps guide how they manage the patient during surgery. However, most felt that tissue oximetry alone is not enough to make management decisions.

In conclusion, the use of tissue oximetry is common among CCAS members, but how it’s used varies a lot.

FAQs

  1. What is the perceived utility of tissue oximetry in pediatric cardiac surgery according to the survey?
  2. How often is tissue oximetry used in different types of surgeries according to the CCAS members’ responses?
  3. What was the common sensor placement configuration for tissue oximetry as reported by the survey respondents?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric cardiac surgery is to trust the expertise of the medical team and follow their recommendations for pre- and post-operative care. It is important to ask questions and communicate any concerns, but ultimately, the doctors and surgeons have the best interest of the child in mind and will provide the best possible care.

Suitable For

Pediatric patients who undergo cardiac surgery with or without cardiopulmonary bypass, as well as those undergoing major noncardiac surgeries, are typically recommended for pediatric cardiac surgery. These patients may have congenital heart defects, acquired heart conditions, or other cardiac abnormalities that require surgical intervention. Additionally, patients undergoing procedures in the cardiac catheterization laboratory may also benefit from pediatric cardiac surgery.

Timeline

Before pediatric cardiac surgery:

  • Patient undergoes preoperative evaluation and assessment by a multidisciplinary team including cardiologists, surgeons, anesthesiologists, and other healthcare professionals.
  • Preoperative testing such as echocardiograms, blood tests, and imaging studies are performed to assess the patient’s cardiac function and overall health.
  • Patient and family receive education about the surgery, potential risks and benefits, and postoperative care.
  • Anesthesia team plans the anesthetic management for the surgery.
  • Surgery is scheduled and the patient is admitted to the hospital.

After pediatric cardiac surgery:

  • Patient is taken to the operating room and undergoes cardiac surgery under general anesthesia.
  • Intraoperative monitoring including tissue oximetry is used to assess tissue oxygenation during the surgery.
  • After surgery, the patient is transferred to the intensive care unit (ICU) for postoperative monitoring and management.
  • Patient is extubated and weaned off mechanical ventilation as tolerated.
  • Pain management and other supportive care are provided as needed.
  • Patient is gradually mobilized and encouraged to participate in physical therapy.
  • Discharge planning and follow-up appointments are scheduled.
  • Patient and family receive education about postoperative care, medications, and potential signs of complications.

Overall, pediatric cardiac surgery involves a comprehensive and coordinated approach to care before and after the procedure to optimize outcomes and ensure the patient’s well-being.

What to Ask Your Doctor

  1. How common is the use of tissue oximetry in pediatric cardiac surgery at your institution?
  2. In what specific procedures or situations is tissue oximetry typically utilized during pediatric cardiac surgery?
  3. Does your institution have a formal protocol or guidelines in place for the use of tissue oximetry in pediatric cardiac surgery?
  4. What is the typical sensor placement configuration for tissue oximetry during pediatric cardiac surgery?
  5. Can you provide examples of how tissue oximetry values have led to clinical management changes in pediatric cardiac surgery cases?
  6. At what point during a procedure do you typically intervene based on tissue oximetry values?
  7. How do you believe tissue oximetry adds value to standard intraoperative monitors during pediatric cardiac surgery?
  8. Do you feel that tissue oximetry alone is sufficient to inform management changes in pediatric cardiac surgery cases?

Reference

Authors: Zaleski KL, Staffa SJ, Kussman BD. Journal: J Cardiothorac Vasc Anesth. 2022 Sep;36(9):3617-3625. doi: 10.1053/j.jvca.2022.05.015. Epub 2022 May 16. PMID: 35691856