Incidence and predictors of postextubation laryngeal edema in pediatric patients with congenital heart disease.

Laryngeal edema developed in 10.1% of studied patients with congenital heart disease after cardiac surgery. The 181 patients were divided into two groups; those with laryngeal edema (group 1) and those without laryngeal edema (group 2). The mean ages in group 1 and 2 were 10 and 22.9 months. Group 1 patients were younger on average than those of group 2 (p < 0.05). The differences in the cardiopulmonary bypass time and anesthesia time between the two groups were not statistically significant. The duration of intubations and ventilatory support before and after the onset of laryngeal edema and the period of the ICU stay were longer in group 1 than in group 2 (P < 0.05). A predictor of postextubation laryngeal edema was not found in our patients from above mentioned parameters. We conclude that the higher incidence of laryngeal edema may be due to young age (most were under 1 year of age), and duration of intubation and ventilatory support.

Pulse oximetry during shunt surgery in pediatric patients with tetralogy of fallot.

Pulse oximetry is a noninvasive technique for measuring O2 saturation (SpO2) continuously. We applied pulse oximetry to 9 pediatric patients with tetralogy of Fallot during shunt surgery. Arterial oxygen tensions (PaO2) and saturations (SaO2) were also measured at the time of postinduction, just before the shunt, after the shunt and at the end of the operation. The SpO2 and SaO2 levels were identically changed in all 4 periods. The PaO2 was increased a little without statistical significance after the shunt procedure and at the end of the operation compared with the values before the shunt. However, SaO2 values increased with statistical significance after the shunt procedure and SpO2 values also showed similar increases with significance. In conclusion, continuous monitoring of SpO2 by pulse oximetry, instead of PaO2, is a very useful and reliable method to assess the improvement of perfusion after shunt, particularly in cyanotic cases.

Comparison of the effects of nicardipine and sodium nitroprusside for control of increased blood pressure after coronary artery bypass graft surgery.

We compared the haemodynamic effects of nicardipine and sodium nitroprusside after coronary artery bypass graft surgery. When post-surgery systolic blood pressure reached > 150 mmHg, patients were randomly given nicardipine (N group, n = 26) or sodium nitroprusside (S group, n = 21). The drugs were infused at a rate of 2 microg/kg per min for 10 min. If the target blood pressure (120-140 mmHg) was not achieved, the infusion rate was increased by 1 microg/kg per min every 10 min. Cardiac and stroke volume indices had increased significantly in the N group after 10 min and in both groups after 60 min. The infusion duration and total dose of drug were significantly lower in the N group compared with the S group. Nicardipine infusion controlled post-operative hypertension more rapidly and was superior to sodium nitroprusside in maintaining left ventricular performance immediately after drug infusion.