Assuntos
Sistemas Computacionais/normas , Ecocardiografia Transesofagiana/normas , Embolia Aérea/diagnóstico por imagem , Monitorização Intraoperatória/normas , Pré-Escolar , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Monitorização Intraoperatória/métodos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: The primary aim of this study was to compare the incidence of accidental arterial puncture during right internal jugular vein (RIJV) cannulation with and without ultrasound guidance (USG). The secondary end points were to assess if USG improves the chances of successful first pass cannulation and if BMI has an impact on incidence of arterial puncture and the number of attempts that are to be made for successful cannulation. SETTINGS AND DESIGN: Prospective observational study performed at a single tertiary cardiac care center. MATERIAL AND METHODS: 255 consecutive adult and pediatric cardiac surgical patients were included. In Group I (n = 124) USG was used for the right internal jugular vein cannulation and in Group II (n = 81) it was not used. There were 135 adult patients and 70 pediatric patients. STATISTICAL ANALYSIS: Demographic and categorical data were analyzed using Student 't' test and chi- square test was used for qualitative variables. RESULTS: The overall incidence of accidental arterial puncture in the entire study population was significantly higher when ultrasound guidance was not used (P< 0.001). In subgroup analysis, incidence of arterial puncture was significant in both adult (P = 0.03) and pediatric patients (P< 0.001) without USG. First attempt cannulation was more often possible in pediatric patients under USG (P = 0.03). In adult patients USG did not improve first attempt cannulation except in underweight patients. CONCLUSIONS: USG helped in the avoidance of inadvertent arterial puncture during RIJV cannulation and simultaneously improved the chances of first attempt cannulation in pediatric and in underweight adult cardiac surgical patients.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Lesões das Artérias Carótidas/etiologia , Cateterismo Venoso Central/efeitos adversos , Veias Jugulares , Punções/estatística & dados numéricos , Ultrassonografia de Intervenção , Índice de Massa Corporal , Cateterismo Venoso Central/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
During the surgical repair of a truncus arteriosus with aortic arch interruption and pulmonary artery origin stenosis, a Contegra conduit was implanted as part of reconstruction of the pulmonary artery in a small infant. There was a mismatch between the conduit size and the patient that resulted in protrusion of the conduit between the sternal edges. To accommodate the conduit inside the thoracic cavity, traction was applied to the sternum that was gradually released over a period of time guided by transesophageal echocardiography-derived cardiac output data, as well as continuous hemodynamic parameters. doi: 10.1111/jocs.12734 (J Card Surg 2016;31:357-360).
Assuntos
Anormalidades Múltiplas , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/complicações , Pectus Carinatum/etiologia , Toracoplastia/métodos , Ecocardiografia , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Masculino , Pectus Carinatum/diagnóstico , Pectus Carinatum/cirurgia , Resultado do TratamentoRESUMO
Hypoxemia is a well-known trigger for precipitating a sickling crisis in patients with sickle cell disease. Patients undergoing staged single ventricle palliation have hypoxemia during the initial stages of the Fontan pathway. The successful completion of staged single ventricle palliation in a child with a combination of homozygous sickle cell disease and a single ventricle physiology that tolerate prolonged hypoxemia during earlier stages of Fontan pathway is described.
