Patent Ductus Arteriosus to von Willebrand Disease

Summary

BACKGROUND

1. ▪ Incidence 1:2,500–5,000 births

2. ▪ More common in prematures

3. ▪ Usually closes spontaneously within days to wks after birth

4. ▪ Persistent L to R shunting may lead to CHF & pulm hypertension if untreated.

5. ▪ Surgical correction by transcatheter closure (coil or device) or surgery (thoracotomy for ligation)

PREOPERATIVE ASSESSMENT

1. ▪ Hx: R/O previous recurrent laryngeal nerve injury

2. ▪ BP: compare extremities

3. ▪ CBC: if chronic cyanosis R/O polycythemia

4. ▪ Echo: assess residual PDA, severity of shunt, direction of flow, RV size & hypertrophy, and estimate RV pressure. R/O other CHD. Evidence of pulm htn: R to L or bidirectional shunting, RV dilation or hypertrophy, cyanosis, or RV dysfunction.

5. ▪ ECG: RVH or LVH

6. ▪ If PDA not corrected, look for pulm htn: cardio consult.

INTRAOPERATIVE MANAGEMENT

1. ▪ SBE prophylaxis indicated if PDA closed within 6 mos

2. ▪ SBE prophylaxis if residual flow or closure device implanted

3. ▪ If PDA uncorrected, be aware of PVR/SVR ratio and direction of shunting.

POSTOPERATIVE CONSIDERATIONS

1. ▪ Std analgesic regimens

POST-OPERATIVE NAUSEA AND VOMITING (PONV)

BACKGROUND

1. ▪ Prevalence higher than adults; schoolchildren up to 50%; infants 5%; preschool children 20%

2. ▪ Intractable vomiting 1–3%

3. ▪ Higher incidence in post-pubertal females

4. ▪ Increased incidence in T&A, strabismus repair, orchiopexy, herniotomy, middle ear surgery & laparotomy

5. ▪ Associated with prolonged surgical/anesthetic time & hx of motion sickness or PONV

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