Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2007
Case ReportsCardiac arrhythmias following anesthesia induction in infantile-onset Pompe disease: a case series.
Patients with infantile-onset Pompe disease suffer from marked hypertrophic cardiomyopathy and an increased risk of arrhythmia. A noncompliant left ventricle predisposes these infants to diastolic heart failure with elevated left ventricular enddiastolic pressure (LVEDP); these patients also commonly develop systolic heart failure. Given this baseline cardiac physiology, coronary perfusion pressure becomes highly sensitive to abrupt changes in diastolic blood pressure (DBP). ⋯ With the advent of enzyme replacement therapy (ERT) using rhGAA, and increased survivability, more infantile Pompe patients will likely present for surgical procedures. Additional care in maximizing coronary perfusion pressure and minimizing arrhythmia risk must be given. For these reasons, it is recommended that anesthesia for infantile Pompe patients specifically avoid propofol or high concentrations of sevoflurane and, instead, use an agent such as ketamine as the cornerstone for induction in order to better support coronary perfusion pressure and to avoid decreasing DBP with vasodilatory agents.
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Paediatric anaesthesia · Aug 2007
Comparative StudyComparison of electrical velocimetry and transpulmonary thermodilution for measuring cardiac output in piglets.
Monitoring of cardiovascular function is essential during major pediatric and pediatric cardiac surgery. Invasive monitoring of cardiac output (CO) and oxygen delivery is expensive and sometimes associated with adverse events. Therefore, we investigated the accuracy of a new noninvasive CO monitoring device using electrical velocimetry (EV) in comparison with the more invasive transpulmonary thermodilution (TPTD) method. ⋯ The results show that EV is a safe, simple, noninvasive and cost-effective method for continuous trend monitoring of CO in piglets. The agreement of the EV-CO with TPTD-CO is not good enough to replace the standard method in our animal model. A correction factor for body habitus in piglets may be beneficial.
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Paediatric anaesthesia · Aug 2007
Children with cardiomyopathy: complications after noncardiac procedures with general anesthesia.
Children with cardiomyopathy (CM) often undergo procedures that require general anesthesia (GA) but little is known about anesthesia-related adverse events or postprocedural outcomes. ⋯ The 30-day mortality rate was low but complications were common, especially in patients with severe ventricular dysfunction. For these patients, we recommend early consideration of perioperative intensive care support to optimize cardiovascular therapy and monitoring.
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Paediatric anaesthesia · Aug 2007
Case ReportsUnilateral postoperative visual loss due to central retinal artery occlusion following cervical spine surgery in prone position.
Postoperative visual loss following spinal surgery is a rare complication. Although a number of intraoperative and postoperative factors have been implicated exact etiology still may remain unclear. We report a case of unilateral postoperative visual loss in a patient who had undergone prolonged spine surgery in a prone position.