The Annals of thoracic surgery
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Severe cyanosis resulting from acquired methemoglobinemia after application of a topical anesthetic, Cetacaine spray, occurred in a 37-year-old patient following bronchoscopy for postoperative atelectasis. Response to methylene blue therapy was dramatic and complete. Attention is drawn to a dangerous adverse effect of this commonly used topical anesthetic agent.
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During the past 5 years, 20 phrenic nerve stimulators have been implanted in 11 patients who were ventilator dependent because of neurogenic respiratory failure. Ten patients had traumatic spinal cord lesions; the remaining patient suffered from a progressive demyelinating disease. There was no operative mortality. ⋯ Three patients became completely independent of their ventilators; 6 became partially independent, thus simplifying nursing care. There were no late complications. As of December, 1979, 7 patients had benefited or were continuing to benefit from phrenic nerve stimulation.
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Thirty infants with various types of cyanotic congenitl heart disease underwent systemic-pulmonary artery shunts with a microporous polytetrafluoroethylene (PTFE) graft between May, 1976, and July, 1979. Sixteen of them were less than 1 month old, and the average age of the neonates was 5.3 days. There were no operative deaths and 5 hospital deaths, 2 related directly to the shunt. ⋯ One patient outgrew the shunt and required secondary shunting procedures. Three of 30 patients have evidenced mild congestive heart failure, which has responded to digitalis. Because of the reliability and excellent late patency of the PTFE prosthesis, we consider it to be superior to a central or Potts shunt for relief from cyanosis in the neonate and infant, and as reliable as a Blalock-Taussig shunt.
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Thirty-six of 87 modified Blalock-Taussig shunts done with expanded polytetrafluoroethylene (Gore-Tex) were restudied angiocardiographically. In 7 patients the study was carried out within 1 month of the shunt operation because the patients failed to make satisfactory clinical progress. ⋯ The remaining 29 patients were reinvestigated electively between 5 and 29 months postoperatively and had a 97% shunt patency rate. Because of the rather high incidence of irregular or stenosed shunts among neonates with 4 mm conduits, we now prefer to use a larger conduit even in this age group.