RESUMO
A 13-year-old girl presented with right ventricular failure secondary to Ebstein's malformation (downward displacement of the tricuspid valve leaflets with adherence to the right ventricular muscle and redundancy or dysplasia of the tricuspid valve leaflets). She subsequently required a heart transplant but developed rhabdomyolysis early in the postoperative period and required ventilatory support for more than 3 weeks. A variety of causes were considered, but her condition improved only when cyclosporin was eliminated from the immunosuppression regimen. We believe it is likely that the rhabdomyolysis has been caused by cyclosporin. If so, this has occurred both earlier in the clinical course and at lower serum concentrations than previously described.
Assuntos
Ciclosporina/efeitos adversos , Transplante de Coração , Imunossupressores/efeitos adversos , Rabdomiólise/induzido quimicamente , Doença Aguda , Adolescente , Anestésicos Intravenosos/uso terapêutico , Creatinina/sangue , Feminino , Humanos , Piperidinas/uso terapêutico , Complicações Pós-Operatórias/induzido quimicamente , Propofol/uso terapêutico , RemifentanilAssuntos
Bacteriemia/diagnóstico , Oxigenação por Membrana Extracorpórea , Controle de Infecções/normas , Infecções por Klebsiella/diagnóstico , Klebsiella pneumoniae/isolamento & purificação , Leite Humano/microbiologia , Diagnóstico Diferencial , Humanos , Recém-Nascido , Intubação Gastrointestinal , MasculinoAssuntos
Anestesia , Anestésicos Inalatórios , Halotano , Adolescente , Broncoscopia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Laringoscopia , Éteres Metílicos , SevofluranoRESUMO
The acute hemodynamic effects of pericardial closure were studied in 30 patients with normal left ventricular function, who were undergoing coronary artery bypass surgery. Closure of the pericardium resulted in decreases in arterial blood pressure (P less than 0.01), cardiac index (P less than 0.001), mean right atrial (P less than 0.001), mean pulmonary artery (P less than 0.001) and pulmonary capillary wedge pressure (P less than 0.001). The observed hemodynamic changes are probably caused by a change in the ventricular pressure-volume relationships.
Assuntos
Ponte de Artéria Coronária , Hemodinâmica , Pericárdio/cirurgia , Pressão Sanguínea , Débito Cardíaco , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/fisiologia , Pressão Propulsora Pulmonar , Volume SistólicoRESUMO
The microbiologic risk of invasive hemodynamic monitoring was studied prospectively in 574 patients undergoing open-heart surgery under cover of cephalothin prophylaxis. Of a total of 2277 catheters inserted in these patients, 1.5% yielded positive cultures. The rate of positive cultures was not significantly different between percutaneous and surgically placed catheters (1.7% vs. 0.8%, respectively). Specifically, the incidence of positive catheter tips for intravenous, central venous, arterial, and pulmonary artery catheters was 1.1%, 3.9%, 1.5%, and 2.1%, respectively; while the corresponding rates for surgically inserted right atrial and left atrial catheters were 0.8% and 0, respectively. Pulmonary artery catheters had a significantly (p less than .01) higher incidence of positive catheter tips after 72 h in situ. However, there was no relationship between the in situ time and the incidence of positive tips for arterial and intravenous catheters. Although the rate of positive catheter tip cultures was low, it affected 4.9% of the patients. Nevertheless, no patient developed catheter-related septicemia or endocarditis, and the data generally supported the microbiologic safety of invasive hemodynamic monitoring in patients undergoing open-heart surgery.