Scholars@Duke
Edmund Hilton Jooste

Edmund Hilton Jooste

Professor of Anesthesiology
Anesthesiology, Pediatrics

Selected Publications

Surgical and Anesthesia-Related Concerns forRobot-Assisted Pediatric Cardiac Surgery.

Journal Article J Cardiothorac Vasc Anesth · November 7, 2025 OBJECTIVE: The purpose of this study is to describe a cohort of pediatric patients undergoing robot-assisted cardiac surgery at a single center and to discuss the anesthetic implications and perioperative considerations to optimize outcomes. DESIGN: A retr ... Full text Link to item Cite

Updates in perioperative hemostasis in the pediatric surgical patient.

Journal Article Curr Opin Anaesthesiol · June 1, 2025 PURPOSE OF REVIEW: Maintaining hemostasis in pediatric patients undergoing major surgery presents unique challenges for the anesthesiologist. This review presents the most recent updates on pediatric perioperative bleeding and hemostasis management. RECENT ... Full text Link to item Cite

Optimizing the anesthetic care of patients with aromatic l-amino acid decarboxylase deficiency.

Journal Article Paediatr Anaesth · February 2025 Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare autosomal recessive disorder that results in a lack of the monoamine neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine. Patients present with a wide spectrum of symptoms, ... Full text Link to item Cite

Anesthesia for Pediatric Cardiac Surgery

Chapter · January 1, 2024 Advances in cardiac surgical techniques and collaboration among subspecialties in cardiac surgery, cardiology, intensive care, and anesthesiology have significantly improved long-term outcomes in children with congenital heart disease. The perioperative ma ... Full text Cite

Neuromonitoring Modalities in Pediatric Cardiac Anesthesia: A Review of the Literature.

Journal Article J Cardiothorac Vasc Anesth · December 2020 Recent decades have witnessed incredible developments in the care of children with congenital heart disease (CHD), such that survival into adulthood is the expected outcome. Improved survival has shifted the focus from improvements in mortality to improvem ... Full text Link to item Cite

The effect of intraoperative methadone during pediatric cardiac surgery on postoperative opioid requirements.

Journal Article Paediatr Anaesth · July 2020 BACKGROUND: Pain control in pediatric patients undergoing cardiac surgery presents a unique challenge. Postoperatively, many of these patients require long-term opioid infusions and sedation leading to need for prolonged weaning from opioids and longer hos ... Full text Link to item Cite

Sedation and Analgesia

Chapter · January 1, 2020 Management of sedation and analgesia in the pediatric patient after cardiac surgery and cardiopulmonary bypass is of particular importance in the setting of decreased cardiac function and increased metabolic oxygen demands secondary to inflammatory respons ... Full text Cite

Cardiac Anesthesia

Chapter · January 1, 2020 Anesthesia for the patient with congenital heart disease (CHD) begins with a comprehensive preoperative evaluation to safely transition patients through different phases of the anesthetic. Anesthesiologists must optimize patient hemodynamics relative to th ... Full text Cite

A Study of Practice Behavior for Endotracheal Intubation Site for Children With Congenital Heart Disease Undergoing Surgery: Impact of Endotracheal Intubation Site on Perioperative Outcomes-An Analysis of the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database.

Journal Article Anesth Analg · October 2019 BACKGROUND: In adults undergoing cardiopulmonary bypass surgery, oral intubation is typically preferred over nasal intubation due to reduced risk of sinusitis and infection. In children, nasal intubation is more common and sometimes preferred due to percei ... Full text Open Access Link to item Cite

Pediatric Transfusion Algorithms: Coming to a Cardiac Operating Room Near You.

Journal Article J Cardiothorac Vasc Anesth · July 2019 Pediatric cardiac surgical patients are at particular risk for post-cardiopulmonary bypass hemorrhage. Moreover, both the incidence and volume of blood transfusions have been associated with increased morbidity in pediatric cardiac patients. Transfusion of ... Full text Link to item Cite

Routine postprocedure ultrasound increases rate of detection of femoral arterial thrombosis in infants after cardiac catheterization.

Journal Article Catheter Cardiovasc Interv · March 1, 2019 OBJECTIVES: To examine the effect of implementing postcatheterization ultrasound (US) on femoral arterial thrombosis detection rates and factors associated with thrombosis in infants. BACKGROUND: Although femoral arterial thrombosis is an uncommon complica ... Full text Link to item Cite

Double-Blind, Randomized, Placebo-Controlled Trial Comparing the Effects of Antithrombin Versus Placebo on the Coagulation System in Infants with Low Antithrombin Undergoing Congenital Cardiac Surgery.

Journal Article J Cardiothorac Vasc Anesth · February 2019 OBJECTIVES: To determine whether precardiopulmonary bypass (CPB) normalization of antithrombin levels in infants to 100% improves heparin sensitivity and anticoagulation during CPB and has beneficial effects into the postoperative period. DESIGN: Randomize ... Full text Link to item Cite

Association Between Early Postoperative Acetaminophen Exposure and Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery.

Journal Article JAMA Pediatr · July 1, 2018 IMPORTANCE: Acute kidney injury (AKI) is a common and serious complication for pediatric cardiac surgery patients associated with increased morbidity, mortality, and length of stay. Current strategies focus on risk reduction and early identification becaus ... Full text Link to item Cite

Percutaneous endoscopic gastrostomy vs surgical gastrostomy in infants with congenital heart disease.

Journal Article Paediatr Anaesth · July 2018 BACKGROUND: Infants with congenital heart disease often require feeding tube placement to supplement oral intake. Gastrostomy tubes may be placed by either surgical or percutaneous endoscopic methods, but there is currently no data comparing outcomes of th ... Full text Link to item Cite

Correlation between minute carbon dioxide elimination and pulmonary blood flow in single-ventricle patients after stage 1 palliation and 2-ventricle patients with intracardiac shunts: A pilot study.

Journal Article Paediatr Anaesth · July 2018 BACKGROUND: Assessment of pulmonary blood flow and cardiac output is critical in the postoperative management of patients with single-ventricle physiology or 2-ventricle physiology with intracardiac shunting. Currently, such hemodynamic data are only obtai ... Full text Link to item Cite

In Vitro Evaluation of the Fresenius Kabi CATSmart Autotransfusion System.

Journal Article J Extra Corpor Technol · June 2017 Use of autotransfusion systems to collect, wash, and concentrate shed blood during surgical procedures is a widely used method for reducing postoperative anemia and the need for blood transfusions. The aim of this study was to evaluate the CATSmart Continu ... Link to item Cite

Natural history of nonimmune-mediated thrombocytopenia and acute kidney injury in pediatric open-heart surgery.

Journal Article Paediatr Anaesth · March 2017 OBJECTIVE: Thrombocytopenia and acute kidney injury (AKI) are common following pediatric cardiac surgery with cardiopulmonary bypass (CPB). However, the relationship between postoperative nadir platelet counts and AKI has not been investigated in the pedia ... Full text Link to item Cite

Phase IV, Open-Label, Safety Study Evaluating the Use of Dexmedetomidine in Pediatric Patients Undergoing Procedure-Type Sedation.

Journal Article Front Pharmacol · 2017 Dexmedetomidine (Precedex™) may be used as an alternative sedative in children, maintaining spontaneous breathing, and avoiding tracheal intubation in a non-intubated moderate or deep sedation (NI-MDS) approach. This open-label, single-arm, multicenter stu ... Full text Link to item Cite

Upper Extremity Peripheral Intravenous Line Infiltration With Concomitant Loss of Pulses Treated With Lipoaspiration: A Case Report.

Journal Article A A Case Rep · November 1, 2016 Peripheral intravenous cannulation in children is associated with occasional morbidity. We present a case where a large volume of blood, administered through a small peripheral cannula in the antecubital fossa, was found to have extravasated into the soft ... Full text Link to item Cite

Reduction in blood transfusion in a cohort of infants having cardiac surgery with cardiopulmonary bypass after instituting a goal-directed transfusion policy.

Journal Article Perfusion · October 2016 BACKGROUND: Current trends in pediatric cardiac surgery and anesthesiology include goal-directed allogeneic blood transfusion, but few studies address the transfusion of platelets and cryoprecipitate. We report a quality improvement initiative to reduce th ... Full text Link to item Cite

In Reply.

Journal Article Anesthesiology · August 2016 Full text Link to item Cite

Cardiopulmonary Bypass Strategy for a Cyanotic Child With Hemoglobin SC Disease.

Journal Article Ann Thorac Surg · June 2016 Hemoglobin SC (HbSC) disease is a hemoglobinopathy that may produce sickling under conditions of hypoxemia, dehydration, and acidosis. We present a case of HbSC disease and tricuspid atresia, type IB. We describe management by cardiopulmonary bypass CPB us ... Full text Link to item Cite

Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery.

Journal Article Anesthesiology · February 2016 BACKGROUND: Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperat ... Full text Open Access Link to item Cite

A change in anticoagulation monitoring improves safety, reduces transfusion, and reduces costs in infants on cardiopulmonary bypass.

Journal Article Paediatr Anaesth · June 2015 BACKGROUND: An immature coagulation system coupled with the hypothermia and hemodilution associated with cardiopulmonary bypass (CPB) in infants makes the activated clotting time (ACT) an ineffective monitor for anticoagulation in this population. The Medt ... Full text Link to item Cite

Ventricular pacing for induced hypotension in a toddler.

Journal Article A A Case Rep · August 1, 2014 Cerebral aneurysm clipping may require periods of hypotension to facilitate dissection and clip application. We describe the use of rapid ventricular pacing to facilitate establishment of controlled hypotension for an 18-month-old child during clipping for ... Full text Link to item Cite

Anesthesia in the cardiac catheterization laboratory and MRI

Chapter · January 1, 2014 Modern pediatric cardiac catheterization laboratories (CCL) have become highly specialized units with an increasing focus on interventional procedures. Furthermore, the cardiac MRI examination is being increasingly used in the management of congenital hear ... Full text Cite

The effect of cisatracurium and rocuronium on lung function in anesthetized children.

Journal Article Anesth Analg · December 2013 BACKGROUND: Neuromuscular blocking drugs have been implicated in intraoperative bronchoconstrictive episodes. We examined the effects of clinically relevant doses of cisatracurium and rocuronium on the lung mechanics of pediatric subjects. We hypothesized ... Full text Link to item Cite

Anesthetic care of parturients with single ventricle physiology.

Journal Article J Clin Anesth · August 2013 Understanding the management of the parturient with single ventricle physiology starts with knowledge of the lesion, the patient's current stage of surgical palliation, her current functional status, and the impact of pregnancy and labor on her cardiac phy ... Full text Link to item Cite

Dexmedetomidine: therapeutic use for the termination of reentrant supraventricular tachycardia.

Journal Article Congenit Heart Dis · 2013 OBJECTIVES: The current drug of choice for reentrant supraventricular tachycardia (SVT) is adenosine followed by verapamil or diltiazem. Although limitations and significant adverse events have been encountered over the years, an alternative effective and ... Full text Link to item Cite

Perioperative use of dexmedetomidine is associated with decreased incidence of ventricular and supraventricular tachyarrhythmias after congenital cardiac operations.

Journal Article Ann Thorac Surg · September 2011 Featured Publication BACKGROUND: Postoperative tachyarrhythmias remain a common complication after congenital cardiac operations. Dexmedetomidine (DEX), an α-2 adrenoreceptor agonist, can have a therapeutic role in supraventricular tachyarrhythmias for cardioversion to sinus r ... Full text Link to item Cite

Acute hemodynamic changes after rapid intravenous bolus dosing of dexmedetomidine in pediatric heart transplant patients undergoing routine cardiac catheterization.

Journal Article Anesth Analg · December 2010 Featured Publication BACKGROUND: Dexmedetomidine is a highly selective α(2)-adrenoceptor agonist with sedative, anxiolytic, and analgesic properties that has minimal effects on respiratory drive. Its sedative and hypotensive effects are mediated via central α(2A) and imidazoli ... Full text Link to item Cite

Effect of dexmedetomidine on pulmonary artery pressure after congenital cardiac surgery: A pilot study.

Journal Article Pediatr Crit Care Med · September 2010 Featured Publication OBJECTIVE: To characterize the effects of dexmedetomidine on the pulmonary artery pressure in patients after congenital cardiac surgery. DESIGN: Prospective observational pilot study. SETTING: Pediatric cardiac intensive care unit at a university hospital. ... Full text Link to item Cite

Electrocardiographic effects of dexmedetomidine in patients with congenital heart disease.

Journal Article Intensive Care Med · May 2010 Featured Publication OBJECTIVE: Assessment of electrocardiographic (ECG) effects of dexmedetomidine. DESIGN: Prospective observational study including children 0-17 years of age with congenital heart disease (CHD) and children following cardiothoracic surgery. Patients who did ... Full text Link to item Cite

Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here?

Journal Article Anesth Analg · February 1, 2010 Featured Publication It has been more than 50 yr since the landmark article in which Holliday and Segar (Pediatrics 1957;19:823-32) proposed the rate and composition of parenteral maintenance fluids for hospitalized children. Much of our practice of fluid administration in the ... Full text Link to item Cite

Coarctation of the Aorta

Chapter · January 1, 2010 Full text Cite

Magnesium supplementation during cardiopulmonary bypass to prevent junctional ectopic tachycardia after pediatric cardiac surgery: a randomized controlled study.

Journal Article J Thorac Cardiovasc Surg · January 2010 Featured Publication OBJECTIVES: We analyzed the role of magnesium sulfate (MgSO(4)) supplementation during cardiopulmonary bypass in pediatric patients undergoing cardiac surgery, assessing the incidence of hypomagnesemia and the incidence of junctional ectopic tachycardia. M ... Full text Link to item Cite

The association of renal dysfunction and the use of aprotinin in patients undergoing congenital cardiac surgery requiring cardiopulmonary bypass.

Journal Article Anesth Analg · July 2009 Featured Publication BACKGROUND: The use of large-dose aprotinin during cardiopulmonary bypass (CPB) in adult patients has been linked to postoperative renal dysfunction, but its effect on the pediatric population undergoing complex congenital cardiac operations is not well de ... Full text Link to item Cite

Neuromuscular blocking agents' differential bronchoconstrictive potential in Guinea pig airways.

Journal Article Anesthesiology · April 2007 Featured Publication BACKGROUND: Neuromuscular blocking agents are designed to antagonize nicotinic cholinergic receptors on skeletal muscle but also antagonize muscarinic receptors. Several muscle relaxants have the potential to promote bronchoconstriction due to unintended e ... Full text Link to item Cite

Rapacuronium augments acetylcholine-induced bronchoconstriction via positive allosteric interactions at the M3 muscarinic receptor.

Journal Article Anesthesiology · December 2005 Featured Publication BACKGROUND: Neuromuscular blocking agents' detrimental airway effects may occur as a result of interactions with muscarinic receptors, allergic reactions, or histamine release. Rapacuronium, a nondepolarizing muscle relaxant, was withdrawn from clinical us ... Full text Link to item Cite

Rapacuronium preferentially antagonizes the function of M2 versus M3 muscarinic receptors in guinea pig airway smooth muscle.

Journal Article Anesthesiology · January 2005 Featured Publication BACKGROUND: Rapacuronium, a nondepolarizing muscle relaxant that was proposed as a replacement for succinylcholine for rapid intubation, was withdrawn from clinical use as a result of fatal bronchospasm, but the mechanism of this effect is not known. Prefe ... Full text Link to item Cite

A mechanism for rapacuronium-induced bronchospasm: M2 muscarinic receptor antagonism.

Journal Article Anesthesiology · April 2003 Featured Publication BACKGROUND: A safe and effective ultra-short-acting nondepolarizing neuromuscular blocking agent is required to block nicotinic receptors to facilitate intubation. Rapacuronium, which sought to fulfill these criteria, was withdrawn from clinical use due to ... Full text Link to item Cite