World journal for pediatric & congenital heart surgery
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World J Pediatr Congenit Heart Surg · Jan 2012
Dexmedetomidine-ketamine sedation in a child with a mediastinal mass.
Sedation during invasive procedures provides appropriate humanitarian care as well as facilitates the completion of procedures. Although generally safe and effective, adverse effects may occur especially in patients with comorbid diseases. ⋯ We present the use of a dexmedetomidine-ketamine combination for procedural sedation in a three-year-old child who presented with a large mediastinal mass and respiratory compromise. Previous reports regarding the use of dexmedetomidine and ketamine for procedural sedation are reviewed and the potential efficacy of this combination is discussed.
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World J Pediatr Congenit Heart Surg · Jan 2012
To cool or not to cool during cardiopulmonary resuscitation.
Therapeutic hypothermia following cardiac arrest improves neurologic outcome following adult ventricular fibrillation (VF) cardiac arrest and perinatal hypoxic ischemic encephalopathy. Evaluation of therapeutic hypothermia in the pediatric cardiac arrest population has been limited thus far to retrospective evaluations and to date there have been no published prospective efficacy trials. Two retrospective pediatric cohort studies showed no benefit from hypothermia compared to usual care. ⋯ Despite this, rewarming has been identified as a vulnerable time for hypotension and seizure activity and may attribute to worse outcome. The American Heart Association's current recommendation is "therapeutic hypothermia (32-34°C) may be considered for children who remain comatose after resuscitation from cardiac arrest. It is reasonable for adolescents resuscitated from sudden, witnessed, out-of-hospital VF cardiac arrest." Ongoing research will help delineate whether induced hypothermia following pediatric cardiac arrest improves neurologic outcome.
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World J Pediatr Congenit Heart Surg · Jan 2012
Multimodality neuromonitoring for pediatric cardiac surgery: our approach and a critical appraisal of the available evidence.
Brain injury remains a source of morbidity associated with congenital heart surgery. Intraoperative neuromonitoring is used by many centers to help minimize neurologic injury and improve outcomes. ⋯ A review of the literature regarding neuromonitoring studies in pediatric cardiac surgery shows that evidence is limited to demonstrate that intraoperative neuromonitoring is associated with improved neurologic outcomes. Further clinical research is needed to assess the utility and cost-effectiveness of intraoperative neuromonitoring for pediatric heart surgery.
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World J Pediatr Congenit Heart Surg · Jan 2012
Arterial switch operation with unidirectional valved patch closure of ventricular septal defect in patients with transposition of great arteries and severe pulmonary hypertension.
For patients with dextro-transposition of great arteries (d-TGAs), ventricular septal defect (VSD), and severe pulmonary arterial hypertension (PAH), the common surgical options are palliative arterial switch operation (ASO) or palliative atrial switch operation leaving the VSD open. We evaluated the role of ASO with VSD closure using a fenestrated unidirectional valved patch (UVP). ⋯ Arterial switch operation with UVP VSD closure is feasible with acceptable early results. It avoids complications of palliative atrial switch (arrhythmia and baffle obstruction) and partially or completely open VSD.
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World J Pediatr Congenit Heart Surg · Jan 2012
Intensive care of the pediatric ventricular assist device patient.
Utilization of ventricular assist devices (VADs) in children is increasing, as is the complexity of patients supported. We review the intensive care management of pediatric patients with VAD in the perioperative and rehabilitation phases, highlighting the technical aspects and physiology of VADs which impact care. Indications for VAD placement and the preoperative assessment of risk are discussed. Specific aspects of postoperative and long-term care including device troubleshooting, hemostasis and anticoagulation, support of the right ventricle, incidence and prevention of neurologic injury, and other complications are reviewed.