Anesthesia and Monitoring[edit | edit source]

Anesthesia: mask induction, then full anesthesia needed including paralytic, patient should be monitored by an anesthesiologist specializing in pediatric cardio-thoracic surgery, monitoring of physiologic alterations: Anesthesia duties  (5 lead EKG, 02, CO2 monitoring, temperature, 2 peripheral venous catheters. Attach safety strap above knees or thigh, all bony prominences padded well.  Lubricate and protect eyes, remove all circumferential tapes and armbands, emergency medications and blood available for patient.  

Intraoperative Monitoring: increase in diastolic BP should be noted after ligation of the PDA.  

Positioning[edit | edit source]
Proper PDA Positioning

Lateral (right side down) with axillary roll and padding between legs.  Left arm is positioned slightly above neck and padded- hips are secured with tape.  

Instruments and Equipment[edit | edit source]
Disposable Equipment[edit | edit source]
  • Pediatric drape/ mayo stand cover/ back table drape
  • Chlorohexidine prep (or other antimicrobial prep)
  • Ioban (optional depending on availability)   
  • Glove & Gowns X3
  • Radio opaque gauze
  • Cautery pencil & grounding pad
  • 15 blade
  • Suction tubing
  • Yankauer tip
  • Chest tube appropriate size for patient
  • Chest tube Atrium
  • Dressing for incision
Suture[edit | edit source]
  • 2-0 SH silk
  • 0 silk ties
  • 5-0 prolene x 1
  • additional 4-0, 5-0 or 6-0 prolene for ligation and division procedure
  • size appropriate Vicryl (or other dissolvable suture)  for muscle
  • size appropriate moncyl ( or other dissolvable monofilament) skin closure
Instruments[edit | edit source]
Instrument Layout
  • 1  Finochetto retractor
  • 2 Army navy retractors
  • 2 malleable
  • 1 metzenbaum  Scissors
  • 1 tenotomy Scissors
  • 1 mayo Scissors
  • 3 regular debakey
  • 12 curved hemostats
  • 1 Castroviejo needle holder
  • 2 regular needle holder
  • 1 Right angle
  • 1 Satinsky  (size appropriate)
  • 1 fine yankuar suction tip
  • 4 non-penetrating towel clamps
  • 1 knife handle

Add for clip ligation: clip applier and appropriate sized clips

Add for ligation and division: an assortment of vascular clamps appropriate length and size for patient

Discussion[View | Edit]

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