Kristine Guleserian, MD, Pediatric Cardiovascular Surgeon, Director of Heart Failure and Heart Transplant Program, Nicholas Children’s Hospital, talks about open heart procedures and the process of pain management during recovery for pediatric patients and a new treatment option.
Interview conducted by Ivanhoe Broadcast News in November 2017.
In general do you see a lot of children that require open heart surgery or a heart procedure?
Dr. Guleserian: Sure, yes we do. We’re actually seeing an increasing number of children, not only neonates and infants but you know toddlers, children, and adolescents who require open heart surgery. And our surgical volume is actually increasing at the moment.
So what are some of the main concerns with pain control for these children because it seems like a very fine line and something certainly parents as well as surgeons are concerned about when it comes to children and the post recovery.
Dr. Guleserian: Sure. When I meet with families preoperatively one of the most common questions that they ask is, will my child be okay, are they going to be in pain after surgery? And that’s after we’ve talked about the surgical procedure. I always like to assure them that we do our best. We’re always on the cutting edge with new therapies to help minimize the trauma and minimize the pain that can be associated with open heart surgery.
So on that note you are using something that is already FDA approved in adults but tell us about your thirteen-year-old patient which you’re using.
Dr. Guleserian: Sure, sure. We’re actually very excited because for the last several months we’ve been using a new drug. It’s called Esperal or liposome bupivacaine and it’s a local analgesic that we can inject in and around the incision after we’ve completed the open heart procedure. And so far the experience that we’ve had has been excellent we have a young girl who several months ago had an open heart procedure and she kept saying gosh I have no pain at all and that was pretty amazing.
Had you in your experience heard because you have done so many of these and children who aren’t old enough to tell you, I mean is it incredible to hear from a patient that she did not have pain afterward?
Dr. Guleserian: It sure is, and especially in the older children and the young adolescents. You know when they’re able to verbalize to you that they are in pain it’s really nice to go by when you’re making rounds and have them smiling. And when you ask them if they’re having pain and they’re still smiling, you know that they’re not, but when you ask the question and they say, no I haven’t had any pain at all it really makes you feel great.
And obviously this kind of adds a little more to your what you’re doing in the OR I guess.
Dr. Guleserian: Actually you know it doesn’t take really any extra time at all. It’s just several small injections through the length of the incision and I tend to us the smaller incisions or the mini sternotomy, so it’s really a limited area. I think the benefits that we’ve seen so far postoperatively have been very promising.
Is every child a good candidate for this or at this point where are you with that?
Dr. Guleserian: So right now even though I know we would all love to apply this new strategy to every single patient that we have at the moment it’s really approved for children who are twelve years of age and older. I think once we have more experience in that age group we should be able to bring it down for the younger children.
I guess bottom line is like you said, this is really an exciting – it’s a game changer.
Dr. Guleserian: Yeah. I think this really is a game changer. No matter how experienced our team is we’re always looking for new things that are on the horizon and here we’ve got innovative tool that I think can make a difference for all of our patients.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Jennifer Caminas
Jennifer.caminas@nicklaushealth.org
305-668-5514
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