Critical care medicine
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Critical care medicine · Oct 1980
Recent advances in the postoperative care of the pediatric cardiac surgical patient.
Contributions from many fields continue to add to the dynamism of the total care experience of the pediatric cardiac surgery patient. Pharmacological support of the myocardium intraoperatively with cardioplegia and postoperatively with the specific beta-adrenergic stimulating drugs, dopamine and dobutamine, have added measureably to the improved outlook of the pediatric cardiac surgical patient. Better control of anticoagulation status and better utilization of blood products are now possible as well.
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Some technical aspects of intraoperative anesthetic care of pediatric surgical patients are discussed. Recent concepts of premedicant, anesthetic and muscle relaxant drugs as related to the pediatric patient are presented. Endotracheal intubation is an integral part of the pediatric anesthetic management. ⋯ Maintenance of a near normal PaCO2 could be accomplished by allowing partial rebreathing during controlled ventilation. Current status of three useful techniques is presented: deliberate hypotension, hemodilution, and the rapid induction-intubation technique for children with a full stomach. Anesthetic considerations of special problems, such as neurosurgery or cardiac surgery and monitoring, are not discussed.
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We studied pulmonary function in 7 infants age 3-16 months who were dependent upon mechanical ventilation due to bronchopulmonary dysplasia (BPD). Raised lower expiratory airway resistance (RAe), low dynamic lung compliance (CL) and rapid respiratory frequency (f) characterized the breathing pattern in these infants. End-tidal carbon dioxide tension (PECO2) was elevated in spite of abnormally high minute ventilation (VE). ⋯ Recovery from chronic respiratory failure in 4 infants occurred between age 1.2-2.5 years. The infants recovered concomitant with the ability to sustain a high VE in spite of persistently elevated RA and low CL. All of the surviving infants, although developmentally delayed, have the potential for home care with further growth and development.