Pediatric cardiology
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Pediatric cardiology · Oct 2012
Hemodynamic effects of dexmedetomidine in critically ill neonates and infants with heart disease.
The primary objective of this study was to evaluate the hemodynamic effects of dexmedetomidine (DEX) infusion on critically ill neonates and infants with congenital heart disease (CHD). The secondary objective of the study was to evaluate the safety and efficacy profile of the drug in this patient population. A retrospective observational study was conducted in the cardiovascular intensive care unit (CVICU) of a single tertiary care university children's hospital. ⋯ There was no substantial difference in major hemodynamic variables between neonates and infants, single- and two-ventricle repair, RACHS 4-6 and RACHS 1-3 categories for patients undergoing surgery, or patients undergoing heart transplantation and patients undergoing other surgical procedures. Dexmedetomidine infusion for neonates and infants with heart disease is safe from a hemodynamic standpoint and can reduce the concomitant dosing of opioid and benzodiazepine agents. Furthermore, DEX infusion may be useful for reducing vasopressor agent dosing in children with catecholamine-refractory cardiogenic shock.
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Pediatric cardiology · Oct 2012
Case ReportsComplete transposition of great arteries with cor triatriatum: an unusual coexistence.
The combination of complete transposition of the great arteries and cor triatriatum is extremely rare. We report three infants with this rare combination and discuss the anatomic details apparently unique to the combined lesion.
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Pediatric cardiology · Oct 2012
Racial and insurance disparities in hospital mortality for children undergoing congenital heart surgery.
Many studies of racial and insurance disparities after congenital heart surgery have used limited regional data over short periods. This study examines the association of race and insurance with hospital mortality using a national hospitalization database spanning almost a decade. A retrospective, repeated cross-sectional analysis was performed. ⋯ Furthermore, Medicaid insurance (OR 1.23, 95% CI 1.15-1.31) and nonwhite race (OR 1.26, 95% CI 1.19-1.34) were associated with nonelective admission for congenital heart surgery. Finally, children with Medicaid insurance (OR 1.18, 95% CI 1.10-1.27) and black children (OR 1.30, 95% CI 1.17-1.44) had higher odds of referral to high-mortality hospitals. Over the past decade, children undergoing congenital heart surgery continued to experience admission, referral, and survival disparities based on insurance and racial status.
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Pediatric cardiology · Oct 2012
Pulmonary stenosis is a predictor of unfavorable outcome after surgery for supravalvular aortic stenosis.
We sought to evaluate whether the presence of pulmonary stenosis (PS), amongst other factors, influences the mortality and the rate of reoperations in the long-term follow-up of patients with supravalvular aortic stenosis (SVAS). We identified all patients with SVAS from our surgical database. The patients with multi-level aortic stenosis or concomitant cardiac procedures were excluded from this study. ⋯ Reoperations were required in 4 patients (15 %), 4-19 years after the original operation, due to aortic arch stenosis, supravalvular restenosis or poststenotic aortic dilatation. PS was found to be a risk factor for reoperation (p = 0.005) and for the combined reoperation/death end-point (p = 0.003). PS in patients with SVAS is a risk factor for reoperations in the aortic region and might be considered an indicator of the severity of the arterial disease and a predictor of an unfavourable outcome.
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Pediatric cardiology · Jun 2012
Randomized Controlled TrialIs the addition of dexmedetomidine to a ketamine-propofol combination in pediatric cardiac catheterization sedation useful?
Pediatric patients undergoing cardiac catheterization usually need deep sedation. In this study, 60 children were randomly allocated to receive sedation with either a ketamine-propofol combination (KP group, n = 30) or a ketamine-propofol-dexmedetomidine combination (KPD group, n = 30). Both groups received 1 mg/kg of ketamine and 1 mg/kg of propofol for induction of sedation, and the KPD group received an additional 1 μg/kg of dexmedetomidine infusion during 5 min for induction of sedation and a maintenance infusion of 0.5 μg/kg/h. ⋯ The mean recovery time was longer in the KP group (5.86 vs 3.13 min; p < 0.05). Adding dexmedetomidine to a ketamine-propofol combination led to a reduced need for airway intervention and to decreased movement during local anesthetic infiltration and throughout the procedure. The recovery time was shorter and hemodynamic stability good in the KPD group.