Open-heart surgery without homologous blood transfusion in infants and children under simple deep hypothermia.

PURPOSE: To investigate the hematological changes during the perioperative period of open-heart surgery without homologous blood transfusion under simple deep hypothermia in infants and small children, and to define the limits of body weight for open-heart surgery without homologous blood transfusion under simple deep hypothermia. METHODS: We performed open-heart surgery without homologous blood transfusion under simple deep hypothermia on eight children, four infants, and a neonate with diagnoses of atrial septal defect, ventricular septal defect, on total anomalous pulmonary venous return (TATVR). All patients except for one with TAPVR were surface-cooled with ice water under deep ether anesthesia. Hematological examinations were performed seven times during the perioperative period. RESULTS: The body weight of the patients ranged from 2.5 to 15.0 kg (mean±SD, 9.5±3.5 kg) and the blood loss from 0.7 to 7.1g·kg-1 (4.6±2.0g·kg-1) The lowest values of the hematological findings in each case after surgery were as follows: Hb ranged from 7.6 to 10.9g·dl-1 (8.8±1.0g·dl-1), blood platelet count from 158×103 to 337×103 cells·µâ„“-1-agonist (271±88 ×103 cells·µâ„“-1-agonist, and total protein from 4.3 to 5.5 g·dl-1 (5.0±0.4g·dl-1) CONCLUSION: Severe anemia and hypoproteinemia were not detected in any case, and, in particular, the reduction of the platelet count was slight. No events occurred as a result of decreased Hb concentration, serum protein, or both.

Lipid peroxide and leukotriene B3 production in patients undergoing cardiopulmonary bypass.

Cardiac surgery with cardiopulmonary bypass (CPB) is frequently associated with a complex array of post-operative clinical abnormalities, including low-output syndrome and pulmonary dysfunction. It has been reported that oxygen free radicals are one of the important factors causing reperfusion injury. To determine whether oxygen free radicals are produced during cardiac surgery, we studied nine patients anesthetized with high doses of fentanyl. Lipid peroxide (LPO) and leukotriene B4 (LTB4) levels increased significantly from 60 min after aortic ligation to 180 min after reperfusion (aortic declamping), compared with the levels before surgery, while superoxide dismutase (SOD) was not affected markedly. Creatine kinase (CK), CK muscle-brain (CK-MB), and neutrophils increased from 60 min after aortic declamping. Correlations were not observed between LPO and CK nor between LPO and CK-MB. These results suggest that free radicals are generated during cardiac surgery with cardiopulmonary bypass (CPB), but it is unclear whether free radicals cause tissue injury after cardiac surgery with CPB.