ABSTRACT
OBJECTIVE@#To compare the median effective dose (ED) of intranasal dexmedetomidine for procedural sedation in uncooperative pediatric patients with acyanotic congenital heart disease before and after cardiac surgery.@*METHODS@#We prospectively recruited 47 children (22 in preoperative group and 25 in postoperative group) who needed sedation for transthoracic echocardiography (TTE). A modified up-and-down sequential study design was employed to determine dexmedetomidine dose for each patient with a starting dose of 2 μg/kg in both groups; dexmedetomidine doses for subsequent subjects were determined according to the responses from the previous subject using the up-and-down method at a 0.25 μg/kg interval. The ED was determined using probit regression. The onset time, examination time, wake-up time and adverse effects were measured, and the safety was evaluated in terms of changes in vital signs every 5 min.@*RESULTS@#The ED value of intranasal dexmedetomidine for sedation was 1.84 μg/kg (95% : 1.68-2.00 μg/kg) in children with congenital heart disease before cardiac surgery, and 3.38 μg/kg (95% : 3.21-3.54 μg/kg) after the surgery. No significant difference was found between the two groups in the demographic variables, onset time, examination time, wake-up time, or adverse effects.@*CONCLUSIONS@#In children with acyanotic congenital heart disease, the ED of intranasal dexmedetomidine for TTE sedation increases to 3.38 μg/ kg after cardiac surgery from the preoperative value of 1.84 μg/kg.
Subject(s)
Child , Humans , Administration, Intranasal , Cardiac Surgical Procedures , Dexmedetomidine , Heart Defects, Congenital , General Surgery , Hypnotics and SedativesABSTRACT
Background: Acyanotic CHD constitute majority of heart defect with significant morbidity, Profile of various defects is essential for identifying children who need urgent intervention and who need to be medically followed. Methods: The study was carried out in Department of Pediatrics and Center of Cardiology, Jawaharlal Nehru Medical College, Aligarh. All patients referred with complaints or clinical examination suggestive of congenital heart defects were further evaluated with echocardiography. On echocardiography patients having congenital heart defects were included as cases which were further divided into cyanotic and acyanotic heart defects, preterms having PDA and PFO and those with acquired heart defects were excluded. The profile and mode of presentation of various acyanotic CHDs was further described in detail. Results: Acyanotic heart defects were 290(72.50%) of the total heart defects, while the contribution of cyanotic heart defects was 110 (27.50%). Out of all CHDs, VSD was the most common lesion with contribution of 152 (38.00%) cases, followed by ASD (20.34%) , PDA (13.10%), PS (6.90%), Subaortic Membrane (2.00%), AV Canal valve defect (1.00%), RSOV (1.00%), Bicuspid Aortic Valve (1.00%), PAPVC (0.66%), Cortriatriatum (0.33%), Coarctation of Aorta(0.33%), ALCAPA(0.33%) and Aortic stenosis (0.33%). Age of presentation for most of the children was between 1 to 5 years. Conclusions: The profile and mode of presentation of various acyanotic heart defects was similar to other studies but diagnosis was delayed in majority of cases. The prevelance of various obstructive lesions like AS, coarctation and bicuspid aortic valve was much lower.
ABSTRACT
PURPOSE: In acyanotic congenital heart disease of children with left to right shunt, 99mTc- Macroaggregate albumin (MAA) was employed to determine the scintigraphic severity of pulmonary parenchymal damage. METHODS: These data of lung perfusion scan using 99mTc-MAA were compared with hemodynamic values obtained from cardiac catheterization. RESULTS: The mean Pulmonary arterial pressure (> or = 30mmHg), total pulmonary resistance (> or = 2 Wood unit) & ratio of pulmonary vascular resistance/systemic resistance (Rp/Rs > or = 0.2) were proportionally related to higher perfusion ratio of upper and lower lung field. The diagnostic values of perfusion ratio of upper & lower field of both lung (cut off value > or = 0.8) for pulmonary hypertension were as follows : 60-65% of sensitivity, 75-90% of specificity, 72-86% of positive predictive value & 68-69% of negative predictive value. The mottled perfusion defect was frequently found in patients with pulmonary hypertension (mean pulmonary arterial pressure > or = 30mmHg, Rp > or = 2 Wood unit). The degree of perfusion defect as indicator of severe pulmonary parenchymal damage was utilized clinically as determinator of operability and morbidity for acyanotic shunt lesions perioperatively. CONCLUSION: The scintigraphic severity determined by 99mTc-MAA lung perfusion scan could be valid for evaluating the extent of pulmonary parenchymal damage in acyanotic congenital heart disease complicated by pulmonary hypertension.