[Effect of tranexamic acid on postoperative bleeding in pediatric heart surgery]. / Efecto del ácido tranexáimico en el sangrado postoperatorio de cirugía cardiaca en pediatría.

OBJECTIVE: To assess the effects of a single dose of tranexamic acid on bleeding and requirement for blood product transfusion in children undergoing cardiac surgery with cardiopulmonary bypass. PATIENTS AND METHODS: A prospective study of closed cohorts undergoing pediatric heart surgery was carried out. The children weighed between 4 and 10 kg. Reoperated and cyanotic patients were included in the sample. The treatment group received 50 mg x kg(-1) of tranexamic acid before surgery. Analyzed data collected during the first 24 hours after surgery were biochemical parameters, bleeding, use of blood products, and D-dimer levels. RESULTS: Fifty-three patients, 25 in the treatment group, were enrolled. Patients on treatment had 24.8% less bleeding in the first 24 hours after surgery (P = .02). The transfusion of blood products was 20% less in the treatment group, although the difference was not significant except in the subgroup of patients who were reoperated. In that group the amount of blood products transfused was 72% less than in the control group (P = .05). D-dimer levels were also lower in the treatment group (P = .003). No adverse effects attributable to the treatment were observed. CONCLUSIONS: A single preoperative dose of tranexamic acid to inhibit fibrinolysis reduces bleeding 24.8% in pediatric patients undergoing heart surgery with cardiopulmonary bypass. The effect is greater in reoperated patients, leading to a reduction in their requirement for transfusion. The use of this therapy in these patients is therefore highly justified.

[Occupational exposure to nitrous oxide and sevoflurane during pediatric anesthesia: evaluation of an anesthetic gas extractor]. / Exposición laboral al óxido nitroso y sevoflurano durante la anestesia en pediatráa: evaluación de un dispositivo de extracción de gases anestésicos.

OBJECTIVES: To determine the level of occupational exposure to anesthetic gases in the absence of an extractor during pediatric anesthesia and to assess the efficacy of a purpose-built extraction system. METHODS: The patients were 24 children undergoing tonsillectomy and adenoidectomy. Gases were extracted from the room for 1 group and were not extracted for the other group (n=12 in each group). Induction was with 8% sevoflurane, 60% nitrous oxide (N2O), 40% oxygen at a flow rate of 8 L x min(-1) through a Mapleson C circuit. Maintenance was with 2% sevoflurane at the same flow rate and gas mixture under spontaneous ventilation with an endotracheal tube and a Mapleson D circuit. The circuits were equipped with an airway pressure-limiting valve to allow connection to an anesthetic gas extractor. Ambient levels of sevoflurane and N2O were measured in the breathing area around the anesthesiologist. The surgeon and the nurse were asked about symptoms related to occupational exposure. RESULTS: The mean (SD) exposure to N2O and sevoflurane in the group without an extractor was 423 (290) and 12 (10.9) parts per million (ppm), respectively. In the group working with the extractor, exposure was 94% and 91% lower: 24.7 (26) and 1.1 (1) ppm (P<.001). A higher incidence of noticing a "smell of gas" was registered for the group without an extractor (87% vs 11% in the extractor group, P=.003). Higher rates were also found for general discomfort (62% vs 11%, P=.05), nausea (62% vs 0%, P=.009), and headache (62% vs 0%, P=.009) in the absence of the extractor. CONCLUSIONS: Gas extraction decreased the level of exposure by up to 94%, achieving levels that were below the recommended limits and greatly reducing occupational risk.

[Upper respiratory tract infections in children: impact on surgical scheduling at a pediatric hospital]. / Repercusión de la infección de vía respiratoria alta en niños sobre la programación quirúrgica en un hospital infantil.

OBJECTIVE: To determine the rate of cancelation of scheduled surgical procedures attributable to upper respiratory tract infection (URTI) in our university pediatric hospital in Madrid and to analyze the effect that literature reviews and appropriate counseling of parents would have on cancelations. MATERIAL AND METHODS: We carried out a retrospective study of the reasons for canceling scheduled pediatric ear, nose, or throat operations in 2001, 2002, 2003, and 2004. Statistical comparisons were performed with the chi2 test. RESULTS: In 2001, 24% of the 641 procedures scheduled were canceled, 12.9% of them because of URTIs. After applying criteria based on a review of the literature, 15% of the 751 procedures were canceled in 2002, 4.9% of them because of URTIs (P<0.0001 in comparison with 2001). In 2003 14.3% of the 760 scheduled procedures were canceled, 6.5% because of URTIs (P<0.0001 in the comparison with 2001). In 2004 12.2% of the 692 scheduled procedures were canceled, 7.2% because of URTIs (P<0.0001 in comparison with 2001). Cancelations in autumn-winter or in spring-summer seasons amounted to 28.2% vs 19.8% in 2001, 17.1% vs 12.7% in 2002, 16.6% vs 11.8% in 2003, and 13.8% vs 11.1% in 2004. CONCLUSIONS: URTIs are responsible for a high rate of cancelations of scheduled operations, particularly in colder seasons of the year. To obtain optimal results, criteria based on up-to-date literature reviews should be put into effect and parents should be given appropriate information.

[Anesthesia for a pediatric multivisceral transplant]. / Anestesia en el trasplante multivisceral en pediatría.

A 15-year-old female with short intestine syndrome due to chronic intestinal pseudo-obstruction associated with kidney failure underwent a multivisceral (stomach-duodenum-jejunum-ileum-pancreas-liver) and kidney transplant. She had required parenteral nutrition for the last 5 years, with numerous complications such as sepsis from the central catheter, deep venous thrombosis, severe liver dysfunction, pancytopenia due to bone marrow failure, and severe malnutrition. Surgery lasted 15 hours and was free of complications other than hypothermia, which worsened after revascularization of the grafts. Replacement of 6 units of blood products and crystalloids was required. Biochemical and hemodynamic variables were stable, apart from the development of hypernatremia, hyperglycemia, and lactic acidosis. The anesthetic approach included preoperative assessment of problems related to chronic parenteral nutrition (liver dysfunction, coagulopathy, and restricted venous access), the prevention of hypothermia, correction of electrolyte imbalance and the acid-base status, treatment of reperfusion syndrome, and the replacement of fluids and blood products to maintain circulatory homeostasis and assure sufficient splanchnic perfusion.