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J Thorac Cardiovasc Surg ; 147(2): 718-23.e1, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23663957


BACKGROUND: From 2002 to 2005, the interstage mortality after a modified Norwood procedure was 7% in our program. An interstage home monitoring program (HMP) was established to identify Norwood procedure patients at increased risk of decompensation and to reduce interstage mortality. METHODS: Results of the first 5 years of the Norwood HMP were reviewed retrospectively. Interstage was defined as the time between Norwood hospital discharge and admission for second stage surgical palliation. In the HMP, families documented oxygen saturation, heart rate, weight, and feedings daily. Nurse practitioners called each family at least weekly, and when issues arose, action plans were determined based on symptom severity. RESULTS: Between October 2005 and October 2010 there were 46 Norwood procedure patients who survived to hospital discharge. All were enrolled in the HMP. Forty-five patients had a Norwood procedure with right ventricle to pulmonary artery conduit, and 1 patient had a modified Blalock-Taussig shunt. Interstage survival was 100%. Nineteen patients (41%) were admitted interstage; 5 patients were admitted twice, 1 patient was admitted 4 times. Seventeen patients (37%) required interstage interventions. Eight patients (17%) required major interventions: conduit stenting, aortic arch balloon angioplasty, emergent shunt, or early Glenn surgery. Minor interventions included supplemental oxygen, blood transfusion, intravenous hydration, diuresis, anti-arrhythmic therapy, or feeding adjustments. CONCLUSIONS: In the first 5 years of the HMP, all infants discharged after a modified Norwood procedure survived the interstage period. The HMP altered clinical management in 37% of patients. Home monitoring of oxygen saturation, heart rate, weight, and feedings, along with comprehensive care coordination, allowed timely interventions and reduced interstage mortality from 7% to 0%.

Cardiopatías Congénitas/cirugía , Insuficiencia Cardíaca/mortalidad , Servicios de Atención a Domicilio Provisto por Hospital , Procedimientos de Norwood/mortalidad , Peso Corporal , Ingestión de Alimentos , Cardiopatías Congénitas/mortalidad , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/enfermería , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/prevención & control , Frecuencia Cardíaca , Humanos , Lactante , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Masculino , Procedimientos de Norwood/efectos adversos , Enfermeras Practicantes , Estado Nutricional , Oxígeno/sangre , Alta del Paciente , Readmisión del Paciente , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
Anesth Analg ; 106(1): 79-83, table of contents, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-18165557


BACKGROUND: Dexmedetomidine (DEX) is an alpha2-adrenergic agonist that is approved by the Food and Drug Administration for short-term (<24 h) sedation in adults. It is not approved for use in children. Nevertheless, the use of DEX for sedation and anesthesia in infants and children appears to be increasing. There are some concerns regarding the hemodynamic effects of the drug, including bradycardia, hypertension, and hypotension. No data regarding the effects of DEX on the cardiac conduction system are available. We therefore aimed to characterize the effects of DEX on cardiac conduction in pediatric patients. METHODS: Twelve children between the ages of 5 and 17 yr undergoing electrophysiology study and ablation of supraventricular accessory pathways had hemodynamic and cardiac electrophysiologic variables measured before and during administration of DEX (1 microg/kg IV over 10 min followed by a 10-min continuous infusion of 0.7 microg x kg(-1) x h(-1)). RESULTS: Heart rate decreased while arterial blood pressure increased significantly after DEX administration. Sinus node function was significantly affected, as evidenced by an increase in sinus cycle length and sinus node recovery time. Atrioventricular nodal function was also depressed, as evidenced by Wenckeback cycle length prolongation and prolongation of PR interval. CONCLUSION: DEX significantly depressed sinus and atrioventricular nodal function in pediatric patients. Heart rate decreased and arterial blood pressure increased during administration of DEX. The use of DEX may not be desirable during electrophysiology study and may be associated with adverse effects in patients at risk for bradycardia or atrioventricular nodal block.

Agonistas alfa-Adrenérgicos/efectos adversos , Dexmedetomidina/efectos adversos , Electrocardiografía , Técnicas Electrofisiológicas Cardíacas , Sistema de Conducción Cardíaco/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Hipnóticos y Sedantes/efectos adversos , Taquicardia Supraventricular/fisiopatología , Adolescente , Agonistas alfa-Adrenérgicos/administración & dosificación , Nodo Atrioventricular/efectos de los fármacos , Nodo Atrioventricular/fisiopatología , Nodo Atrioventricular/cirugía , Presión Sanguínea/efectos de los fármacos , Ablación por Catéter , Niño , Dexmedetomidina/administración & dosificación , Femenino , Sistema de Conducción Cardíaco/fisiopatología , Sistema de Conducción Cardíaco/cirugía , Humanos , Hipnóticos y Sedantes/administración & dosificación , Infusiones Intravenosas , Masculino , Mecánica Respiratoria/efectos de los fármacos , Nodo Sinoatrial/efectos de los fármacos , Nodo Sinoatrial/fisiopatología , Nodo Sinoatrial/cirugía , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/cirugía , Resultado del Tratamiento