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1.
J Cardiothorac Vasc Anesth ; 35(10): 2907-2912, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33431272

RESUMO

OBJECTIVES: The monitoring of cerebral tissue oxygen saturation by near-infrared spectroscopy (ScerebO2) is used widely in pediatric cardiac anesthesia. However, little information is available on the effects of changes in perioperative ScerebO2 on brain morphology and neurologic outcome. The primary hypothesis tested in this study was that intraoperative ScerebO2 during the comprehensive stage II procedure correlated with brain volumes assessed by magnetic resonance imaging and neurodevelopmental scores. DESIGN: Retrospective observational cohort study. SETTING: University Hospital, Pediatric Heart Centre. PATIENTS AND MEASUREMENTS: In 19 infants, the intraoperative course of ScerebO2 during the comprehensive stage II procedure was examined. Minimal ScerebO2 and integrated ScerebO2 below 45% (AUC) during surgery, as well as cerebral magnetic resonance imaging (MRI) examinations and Bayley III test at the ages of two-to-three years, were analyzed. MAIN RESULTS: A positive correlation between minimal ScerebO2 and intracranial volume (p = 0.0243), total brain volume (p = 0.0243), and white matter volume (p = 0.0276) was observed, as was a negative correlation between AUC and intracranial volume (p = 0.0454) and white matter volume (p = 0.0381), respectively. No association was found between ScerebO2 and Bayley-III Score. CONCLUSION: The correlation between ScerebO2 and brain volumes measured by MRI pointed out a possible importance of neuroprotective strategies aimed at optimizing ScerebO2 during complex congenital heart surgery. That no correlation between ScerebO2 and Bayley III Score was found suggested multifactorial causes for neurologic outcome in children with congenital heart defects.


Assuntos
Cardiopatias Congênitas , Síndrome do Coração Esquerdo Hipoplásico , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico por imagem , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Lactente , Oxigênio , Estudos Retrospectivos
2.
Paediatr Anaesth ; 30(6): 691-697, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32291873

RESUMO

BACKGROUND: Neonatal management of patients with hypoplastic left heart syndrome and complex remains a challenging task, whereby the "hybrid" palliation is often reserved for high-risk patients as a "rescue" procedure. AIM: This study documents the anesthetic challenges and potential complications associated with the Giessen hybrid stage I approach. METHODS: The Giessen hybrid stage I approach is focused on surgical bilateral pulmonary artery banding. Retrospective perioperative data were analyzed. Contrary to a stable group A, inotropic treatment before surgery for treatment of postnatal shock classified patients as unstable (Group B). Clinical outcomes considered were inhospital mortality, duration of postoperative mechanical ventilation, postoperative time at the intensive care unit, perioperative vasoactive medication requirements, and red blood cell transfusion. RESULTS: From June 1998 to December 2015, 185 patients were allocated to Group A (n = 165) and Group B (n = 20). The inhospital mortality was 2.2% with no difference between the groups. There was also no difference in the postoperative time on mechanical ventilation and the time in the intensive care unit. Vasoactive medication was more often required in Group B (100%) compared to Group A (19%). In Group B, more red blood cells were transfused 6.0 ± 8.3 vs 2.0 ± 5.8 mL/kg in Group A (P < .05, 95% CI 0.0 - 2.6). CONCLUSION: Considering a learning curve, anesthesia for surgical bilateral pulmonary artery banding palliating patients with hypoplastic left heart syndrome and complex can safely be performed, independent from the preoperative clinical status.


Assuntos
Anestesia , Técnica de Fontan , Síndrome do Coração Esquerdo Hipoplásico , Humanos , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Recém-Nascido , Cuidados Paliativos , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
3.
Thorac Cardiovasc Surg ; 65(5): 403-409, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27043787

RESUMO

Background Lung transplantation is the only treatment option for many patients with end-stage pulmonary disease. Therefore, postthoracotomy pain therapy is of vital interest. Thoracic epidural analgesia (EPI) is the "gold standard" for postthoracotomy pain, but especially in lung transplantation contraindications, and potential infectious complications limit its advantages. Under these circumstances surgically placed postthoracotomy catheter-assisted continuous paravertebral intercostal nerve block (PVB) could be of advantage. Methods We performed a retrospective cohort study of patients who underwent lung transplantation between 2005 and 2012. Groups were defined according to the type of postoperative pain therapy: PVB, EPI, and SYS (systemic analgesia). Total 44 patients were eligible. Results Postoperative opioid requirement of the PVB and EPI group was comparable and less than that of the SYS group. Patients of the PVB group were weaned earlier from mechanical ventilation after lung transplantation. Conclusion The potency of postoperative pain therapy of EPI and PVB seemed to be comparable and superior to SYS. Considering the risks and benefits, PVB could be a better choice than EPI for postthoracotomy pain therapy, especially in lung transplantation.


Assuntos
Analgesia Epidural , Anestésicos Locais/administração & dosagem , Cateteres de Demora , Nervos Intercostais , Transplante de Pulmão/efeitos adversos , Bloqueio Nervoso/instrumentação , Dor Pós-Operatória/prevenção & controle , Toracotomia/efeitos adversos , Analgesia Epidural/efeitos adversos , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/efeitos adversos , Humanos , Transplante de Pulmão/métodos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Seleção de Pacientes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Desmame do Respirador
5.
A A Pract ; 14(1): 1-5, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31651415

RESUMO

Cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) present a challenging task for anesthesia providers. Anesthesia management may be complicated by hyperthermia, fluid shifts, and distinct inflammatory response. Only a few reports dealing with the anesthesia management of pediatric CS and HIPEC have been published. We report a case of a 2-year-old child with a relapse of an alveolar rhabdomyosarcoma of the uterus and peritoneal carcinomatosis treated with CS and HIPEC. For children, careful temperature measurement, intraoperative prevention of hyperthermia, and sufficient volume management are important, as well as postoperative pediatric intensive care with experience CS and HIPEC patients.


Assuntos
Anestésicos/administração & dosagem , Recidiva Local de Neoplasia/terapia , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Rabdomiossarcoma Alveolar/terapia , Neoplasias Uterinas/terapia , Temperatura Corporal/efeitos dos fármacos , Pré-Escolar , Cisplatino/administração & dosagem , Cisplatino/farmacologia , Terapia Combinada , Cuidados Críticos , Procedimentos Cirúrgicos de Citorredução , Evolução Fatal , Feminino , Humanos , Hipertermia Induzida , Cuidados Pós-Operatórios
6.
Minerva Anestesiol ; 85(1): 45-52, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30207132

RESUMO

BACKGROUND: The LMA Protector™ Airway (The Laryngeal Mask Company Ltd., Teleflex Incorporated, Athlone, Ireland) is a new supraglottic airway promising a better seal, an improved drainage of gastric secretions and the opportunity of a simplified fiberscopy-guided tracheal intubation. The aim of this study was to present a primary evaluation of the LMA Protector in a clinical setting. METHODS: After informed consent 50 patients, scheduled for minor/moderate surgery in supine position, were recruited. Pharyngeal seal pressures were examined in neutral position of the patients' head and in maximum passive extension of the neck. Additionally, the fiberscopic view on the glottis was graduated and the feasibility of fiberscope guided tracheal intubation through the device was evaluated. RESULTS: The median pharyngeal seal pressure of the LMA Protector in neutral position of the head was 34 cmH2O. Passive extension of the neck did not cause a reduction of the pharyngeal seal (median pharyngeal seal pressure: 34.7 cmH2O; P<0.039). The LMA Protector was applicable for fiberscopic tracheal intubation but is not reliable for blind tracheal intubation. CONCLUSIONS: The LMA Protector provides a high pharyngeal seal. Uncommon for laryngeal masks its pharyngeal seal is not affected by the extension of the patient's neck. As a second generation supraglottic airway which is also suitable for simplified fiberscopic guided tracheal intubation, the LMA Protector could be considered as a supraglottic airway of the third generation.


Assuntos
Máscaras Laríngeas , Manuseio das Vias Aéreas , Estudos de Coortes , Feminino , Tecnologia de Fibra Óptica , Glote/anatomia & histologia , Humanos , Intubação Intratraqueal , Máscaras Laríngeas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pescoço , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Decúbito Dorsal
7.
Semin Cardiothorac Vasc Anesth ; 23(4): 393-398, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31431128

RESUMO

Background. The absolute number of patients presenting with failure of the hemi-Fontan or Fontan circulation for cardiac transplantation (cTx) will continuously rise. We aimed to analyze the intraoperative differences in patients undergoing cTx for a failing hemi-Fontan or Fontan circulation (group A) with those undergoing cTx for cardiomyopathy and congenital heart disease (group B). Methods. Data of patients undergoing cTx during a 10-year period were compared between group A and group B patients. Results. cTx was performed in 83 patients (group A, n = 21; group B, n = 62). Surgical times including median incision-suture time (549 minutes vs 386 minutes, P < .05) and median organ ischemia time (305 minutes vs 233 minutes, P < .05) were longer in group A patients. After weaning off cardiopulmonary bypass a higher median modified Vasoactive Inotropic Score (16 vs 10, P < .05) was necessary in group A patients. During surgery more fresh frozen plasma (44 mL/kg vs 20 mL/kg, P < .05), platelet concentrates (20 mL/kg vs 14 mL/kg, P < .05), and coagulation factor concentrates were given in group A patients. Mortality during the first 90 days after cTx was higher in group A (23.8% vs 6.5%, P < .05). Conclusion. Patients undergoing cTx for a failing hemi-Fontan or Fontan circulation are challenging. They require an intensive vasoactive and inotropic support; furthermore, special attention should be paid to the management of bleeding complications. cTx for this group of patients is associated with higher 90 days mortality.


Assuntos
Anestesia/métodos , Cardiomiopatias/cirurgia , Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Transplante de Coração/métodos , Adolescente , Adulto , Ponte Cardiopulmonar , Criança , Pré-Escolar , Humanos , Lactente , Duração da Cirurgia , Estudos Retrospectivos , Falha de Tratamento , Adulto Jovem
8.
J Clin Anesth ; 18(4): 256-63, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16797426

RESUMO

OBJECTIVE: To evaluate the performance of 4 published prognostic models for postoperative onset of nausea and vomiting (PONV) by means of discrimination and calibration and the possible impact of customization on these models. DESIGN: Prospective, observational study. SETTING: Tertiary care university hospital. PATIENTS: 748 adult patients (>18 years old) enrolled in this study. Severe obesity (weight > 150 kg or body mass index > 40 kg/m) was an exclusion criterion. INTERVENTIONS: All perioperative data were recorded with an anesthesia information management system. A standardized patient interview was performed on the postoperative morning and afternoon. MEASUREMENTS: Individual PONV risk was calculated using 4 original regression equations by Koivuranta et al, Apfel et al, Sinclair et al, and Junger et al Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was tested using Hosmer-Lemeshow goodness-of-fit statistics. New predictive equations for the 4 models were derived by means of logistic regression (customization). The prognostic performance of the customized models was validated using the "leaving-one-out" technique. MAIN RESULTS: Postoperative onset of nausea and vomiting was observed in 11.2% of the specialized patient population. Discrimination could be demonstrated as shown by areas under the receiver operating characteristic curve of 0.62 for the Koivuranta et al model, 0.63 for the Apfel et al model, 0.70 for the Sinclair et al model, and 0.70 for the Junger et al model. Calibration was poor for all 4 original models, indicated by a P value lower than 0.01 in the C and H statistics. Customization improved the accuracy of the prediction for all 4 models. However, the simplified risk scores of the Koivuranta et al model and the Apfel et al model did not show the same efficiency as those of the Sinclair et al model and the Junger et al model. This is possibly a result of having relatively few patients at high risk for PONV in combination with an information loss caused by too few dichotomous variables in the simplified scores. CONCLUSIONS: The original models were not well validated in our study. An antiemetic therapy based on the results of these scores seems therefore unsatisfactory. Customization improved the accuracy of the prediction in our specialized patient population, more so for the Sinclair et al model and the Junger et al model than for the Koivuranta et al model and the Apfel et al model.


Assuntos
Modelos Estatísticos , Otorrinolaringopatias/cirurgia , Náusea e Vômito Pós-Operatórios/etiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea e Vômito Pós-Operatórios/prevenção & controle , Período Pós-Operatório , Valor Preditivo dos Testes
9.
J Thorac Cardiovasc Surg ; 151(4): 1112-21, 1123.e1-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26704055

RESUMO

OBJECTIVE: This retrospective study presents our operative results, mortality, and morbidity with regard to pulmonary artery growth and reinterventions on the pulmonary artery and aortic arch, including key features of our institutional standards for the 3-stage hybrid palliation of patients with hypoplastic left heart syndrome. METHODS: Between June 1998 and February 2015, 182 patients with hypoplastic left heart structures underwent the Giessen hybrid stage I procedure. Among these, 126 patients with hypoplastic left heart syndrome who received a univentricular palliation or heart transplantation were included in the main analysis. Median age and body weight of patients at hybrid stage I were 6 days (0-237) and 3.2 kg (1.2-7), respectively. Comprehensive stage II operation was performed at 4.5 months (2.9-39.5), and Fontan completion was established at 33.7 months (21.1-108.2). Operative and interstage mortality, morbidity, growth and reinterventions on the pulmonary arteries, and long-term operative results of the aortic arch reconstruction were assessed. RESULTS: Median follow-up time after Giessen hybrid stage I palliation was 4.6 years (0-16.8). Operative mortality at hybrid stage I, comprehensive stage II, and Fontan completion was 2.5%, 4.9%, and 0%, respectively. Cumulative interstage mortality was 14.2%. At 10 years, the probability of survival is 77.8%. Body weight (<2.5 kg) and aortic atresia had no significant impact on survival. McGoon ratio did not differ at comprehensive stage II and Fontan completion (P = .991). Freedom from pulmonary artery intervention was estimated to be 32.2% at 10 years. Aortic arch reinterventions were needed in 16.7% of patients; 2 reoperations on the aortic arch were necessary. CONCLUSIONS: In view of the early results and long-term outcome, the hybrid approach has become an alternative to the conventional strategy to treat neonates with hypoplastic left heart syndrome and variants. Further refinements are warranted to decrease patient morbidity.


Assuntos
Técnica de Fontan , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimentos de Norwood , Adolescente , Aorta Torácica/fisiopatologia , Aorta Torácica/cirurgia , Implante de Prótese Vascular , Criança , Pré-Escolar , Técnica de Fontan/efeitos adversos , Técnica de Fontan/mortalidade , Alemanha , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Lactente , Estimativa de Kaplan-Meier , Procedimentos de Norwood/efeitos adversos , Procedimentos de Norwood/mortalidade , Cuidados Paliativos , Artéria Pulmonar/crescimento & desenvolvimento , Artéria Pulmonar/cirurgia , Circulação Pulmonar , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
J Thorac Cardiovasc Surg ; 149(4): 1112-20; discussion 1120-2.e2, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25439773

RESUMO

OBJECTIVE: This article presents the long-term results of our patients with a diagnosis of hypoplastic left heart syndrome (HLHS), hypoplastic left heart complex (HLHC), and variants who received a biventricular repair following hybrid stage I with ductal stenting and bilateral pulmonary artery banding. METHODS: Between June 1998 and June 2013, a total of 154 patients with hypoplastic left heart structures underwent a hybrid stage I procedure. Forty patients were definitely treated by creating a biventricular circulation. Median age and body weight of patients before hybrid stage I were 8.5 days (2-40) and 3.0 kg (1.6-3.8), respectively. The diagnoses were HLHS with mitral and aortic stenosis (n = 7), HLHC (n = 15), HLHC with interrupted aortic arch (n = 9), critical aortic stenosis with hypoplastic aortic arch (n = 4), imbalanced atrioventricular septal defect with hypoplastic aortic arch (n = 2), double-outlet right ventricle with hypoplastic aortic arch (n = 2), and d-transposition of the great arteries with interrupted aortic arch (n = 1). Median age at the time of biventricular correction was 6.7 months (1.6-13.8). The patients were treated with direct biventricular correction, including repair of intracardiac defects (n = 32), Norwood/Rastelli or Yasui (n = 4), arterial switch (n = 2), Rastelli (n = 1), and Ross-Konno (n = 1) operations with ascending aortic/aortic arch reconstruction. RESULTS: All patients survived hybrid stage I. Median survival after biventricular correction is 7.9 years (0.9-14.9). Overall mortality was 10% (4 patients) at 4 weeks, 5 weeks, 6 weeks, and 4 months after biventricular correction, respectively. One patient had to be switched to univentricular circulation and another patient underwent orthotopic heart transplantation 3 and 4 months after biventricular correction, respectively. CONCLUSIONS: The Giessen hybrid approach is an alternative to the conventional strategy to treat neonates with HLHS, HLHC, and variants. Biventricular repair after hybrid stage I is feasible and can be performed with satisfactory long-term survival.


Assuntos
Cateterismo Cardíaco , Ventrículos do Coração/cirurgia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimentos de Norwood , Artéria Pulmonar/cirurgia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Estudos de Viabilidade , Ventrículos do Coração/anormalidades , Ventrículos do Coração/crescimento & desenvolvimento , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Procedimentos de Norwood/efeitos adversos , Procedimentos de Norwood/mortalidade , Cuidados Paliativos , Artéria Pulmonar/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
11.
Paediatr Anaesth ; 18(2): 125-31, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18184243

RESUMO

BACKGROUND: Infiltrative anesthesia of the scalp with lidocaine was used in an attempt to reduce blood loss and anesthetic requirements during pediatric craniofacial surgery. Lidocaine, however, has the potential to cause methemoglobinemia. In this retrospective cohort-study we analyzed the incidence and effects of postoperative methemoglobinemia following subcutaneous lidocaine administration. METHODS: During 1999-2006, 50 infants (age: 3-31 months) undergoing elective craniofacial surgery were analyzed. All infants received general anesthesia and routine monitoring, including invasive arterial blood pressure measurement. Prior to incision, the scalp was infiltrated with 6-15 ml lidocaine 1% (with epinephrine 1 : 200.000). Blood loss and blood transfusions were recorded. Methemoglobin (Met-Hb) levels were determined postoperatively using co-oximetry. RESULTS: Twenty percent of the operated infants showed elevated Met-Hb levels (median of maximal levels: 6%; range: 2.2-18%) at admission on the PICU. In 80% of these methemoglobinemia resolved spontaneously within 12 h, only two children received methylene blue because of visible cyanosis. The intra- and postoperative course was otherwise uneventful in all the children despite significant total blood loss (median of blood loss as percentage from total estimated blood volume: 43%; range: 11-110%). Lidocaine was the only substance identified to have the potential to cause methemoglobinemia. However, the average administered dose of lidocaine was not significantly different between patients with or without methemoglobinemia (13 +/- 3.1 vs 12 +/- 3.5 mg.kg(-1); P = 0.37). CONCLUSIONS: Even though we did not measure lidocaine plasma levels, lidocaine was the most likely cause of postoperative methemoglobinemia. Despite a high incidence, methemoglobinemia occurred sporadically and was without dangerous consequences.


Assuntos
Anestesia Geral , Anestésicos Locais/efeitos adversos , Lidocaína/efeitos adversos , Metemoglobinemia/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Anestésicos Combinados , Anormalidades Craniofaciais/cirurgia , Feminino , Humanos , Lactente , Masculino , Metemoglobinemia/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos
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