ABSTRACT
During the past decade, a hybrid procedure has emerged and dramatically evolved as an alternative stage I palliation to the conventional Norwood procedure in neonates with hypoplastic left heart syndrome (HLHS). The hybrid approach avoids the need for cardiopulmonary bypass (CPB) utilizing stenting of the arterial duct and bilateral pulmonary artery banding. Cerebral and coronary perfusion pressure is maintained, and the pulmonary vasculature is protected from higher systemic pressure. Elimination of risks associated with CPB gains vital time to stabilize the patient and correct coexisting noncardiac anomalies and allows growth in preparation for the later stages of the Fontan pathway. The association of HLHS with right congenital diaphragmatic hernia (CDH) is rare. We report performing a successful hybrid stage I palliation on a neonate with HLHS and severe right CDH.
Subject(s)
Hernias, Diaphragmatic, Congenital/surgery , Hypoplastic Left Heart Syndrome/surgery , Stents , Cardiopulmonary Bypass/adverse effects , Cardiopulmonary Bypass/methods , Female , Hernias, Diaphragmatic, Congenital/physiopathology , Humans , Hypoplastic Left Heart Syndrome/physiopathology , Infant, Newborn , Severity of Illness Index , Treatment OutcomeSubject(s)
Anesthesia Recovery Period , Anesthesia, General/adverse effects , Baclofen/poisoning , Hemodynamics/drug effects , Muscle Relaxants, Central/poisoning , Baclofen/administration & dosage , Blood Pressure/drug effects , Child , Drug Overdose , Heart Rate/drug effects , Humans , Injections, Spinal , Male , Medical Errors , Muscle Relaxants, Central/administration & dosageABSTRACT
Oral rehydration with sucrose-electrolyte solutions is now established as a safe and effective way to treat dehydrated children in hospital. In Jamaica, oral rehydration with World Health Organization approved packets of glucose-electrolyte salts supplied by the United Nations International Children's Emergency Fund has been successfully introduced in the main children's hospitals in Kingston. However, because of the difficulty of supplying packets to scattered urban and rural community clinics, mothers are advised by health personnel as well as on radio and television programmes to prepare various homemade sugar-salt solutions to treat children with diarrhoea at home. The composition of solutions prepared by mothers varies dangerously. To reduce errors, a double ended spoon has been designed to help mothers to make up solutions more accurately. The value of the spoon has been established under the most favourable conditions. To obtain the maximum rate of absorption of water and electrolytes in dehydrated children, the oral solution should approximate closely to the WHO recommended solution which contains glucose 110 mmol/l (sucrose 210 mmol/l), sodium 90mmol/l, potassium 20 mmol/l, chloride ions 80 mmol/l, and bicarbonate 30 mmol/l. We compared the composition of salt-sugar solutions prepared by Jamaican mothers according to current health education and those prepared by means of the double-ended spoon. (AU)