{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T22:00:56Z","timestamp":1782252056983,"version":"3.54.5"},"reference-count":21,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,9,8]],"date-time":"2024-09-08T00:00:00Z","timestamp":1725753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with hypoplastic left heart syndrome undergo the comprehensive stage 2 procedure as the second stage in the hybrid approach toward Fontan circulation. The complexity of comprehensive stage 2 procedure is considered a potential limitation, and limited information is available on its anesthetic management. This study aims to address this gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A single\u2010center retrospective cohort study analyzed 148 HLHS patients who underwent comprehensive stage 2 procedure, divided into Group A (stable condition,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009116) and Group B (requiring preoperative intravenous inotropic therapy,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200932). Demographic data, intraoperative hemodynamics, anesthetic management, and postoperative outcomes were collected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Etomidate (40%) was the most common induction agent, followed by esketamine (24%), midazolam (16%), and propofol (13%). Inhaled induction was rarely necessary (2%), occurring only in Group A patients. No statistical differences were found between groups for induction drug choice. Post\u2010cardiopulmonary bypass management included moderate hypoventilation, inhaled nitric oxide (100%), and hemodynamic support with milrinone (97%) and norepinephrine (77%). Group B patients more frequently required additional levosimendan (20%) and epinephrine (18%). Extracorporeal membrane oxygenation was necessary in 8 patients (5%) with no between\u2010group differences. Switching from fentanyl to remifentanil reduced postoperative ventilation time overall. However, Group B experienced significantly longer ventilation (6.3 vs. 3.5\u2009h) and ICU stay (22 vs. 14\u2009days). In\u2010hospital mortality was 5% overall (Group A: 4%, Group B: 9%). Long\u2010term survival analysis revealed a significant advantage for Group A.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The use of short\u2010acting opioids and adjusted ventilation modes enables optimal pulmonary blood flow and rapid transition to spontaneous breathing. Differentiated hemodynamic support with milrinone, norepinephrine, supplemented by levosimendan and epinephrine in high\u2010risk patients, can mitigate the effects on the preoperatively volume\u2010loaded right ventricle. However, differences in long\u2010term survival probability were observed between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Local ethics committee, Medical Faculty, Justus\u2010Liebig\u2010University\u2010Giessen (Trial Code Number: 216\/14).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pan.14995","type":"journal-article","created":{"date-parts":[[2024,9,8]],"date-time":"2024-09-08T05:38:21Z","timestamp":1725773901000},"page":"1223-1230","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Perioperative anesthetic management of patients with hypoplastic left heart syndrome undergoing the comprehensive stage\n                    <scp>II<\/scp>\n                    surgery\u2014A review of 148 cases"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6546-9860","authenticated-orcid":false,"given":"Matthias","family":"M\u00fcller","sequence":"first","affiliation":[{"name":"Pediatric Cardiac Anesthesiology Service, Pediatric Heart Centre, Department of Anesthesiology Intensive Care Medicine, Pain Therapy University Hospital Giessen and Marburg GmbH  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Lurz","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Anesthesiology Service, Pediatric Heart Centre, Department of Anesthesiology Intensive Care Medicine, Pain Therapy University Hospital Giessen and Marburg GmbH  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Zajonz","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Anesthesiology Service, Pediatric Heart Centre, Department of Anesthesiology Intensive Care Medicine, Pain Therapy University Hospital Giessen and Marburg GmbH  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Edinger","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Anesthesiology Service, Pediatric Heart Centre, Department of Anesthesiology Intensive Care Medicine, Pain Therapy University Hospital Giessen and Marburg GmbH  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uygar","family":"Y\u00f6r\u00fcker","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Congenital Heart Surgery, Pediatric Heart Centre University Hospital Giessen and Marburg GmbH  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Thul","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pediatric Heart Centre University Hospital Giessen and Marburg GmbH  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Schranz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pediatric Heart Centre University Hospital Giessen and Marburg GmbH  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan","family":"Akint\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Congenital Heart Surgery, Pediatric Heart Centre University Hospital Giessen and Marburg GmbH  Giessen 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