Journal of pediatric surgery
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Despite advances in mechanical ventilatory support for patients with smoke inhalation injury, including the use of high-frequency flow-interruption ventilators such as the VDR, inhalation injury alone may increase mortality by as much as 20% in patients with thermal injury, and up to 60% when pneumonia occurs. Inhalation injury causes a primary large and small airway epithelial insult that results in ventilation abnormalities, rather than a primary alveolar lesion that results in oxygenation abnormalities as occur in multiple-system organ failure. ⋯ Early identification of such patients will allow rapid conversion to other methods of ventilatory support that effect gas exchange, with minimal risk of further barotrauma, while inhalation injury healing occurs. Such predictors may be developed for other disease processes that are characterized by severe pulmonary ventilatory dysfunction.
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The incidence of inguinal hernia and incarceration is high among premature infants. Optimal timing, anesthetic technique, and long-term results of hernia repair in hospitalized premature infants remain undefined. The authors reviewed the records of 52 consecutively treated premature infants who underwent bilateral inguinal herniorrhaphy under general anesthesia before discharge from the intensive care nursery. ⋯ One recurrence was identified, representing 4% of the long-term follow-up group and 2% of the initial population. Two patients had asymmetric testicular volumes suggestive of unilateral atrophy. The short- and long-term results suggest that repair under general anesthesia can be safely performed before discharge from the intensive care nursery.
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The authors reviewed the Extracorporeal Life Support Organization (ELSO) data base of all neonates placed on extracorporeal membrane oxygenation for whom CDH was diagnosed between January 1989 and December 1991. For 483 neonates, there were complete data concerning timing of the hernia repair in relation to ECMO. The overall incidence of hemorrhage was 43% (57% among nonsurvivors, 32% among survivors; P < .05). ⋯ The incidence of hemorrhagic complications did not differ significantly among the 3 years (P > .05). Repair of the hernia defect while on bypass was associated with significantly greater bleeding complications. These data should be useful in the planning of future prospective trials.
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With the increase in popularity of delayed repair of congenital diaphragmatic hernia (CDH), many institutions are using extracorporeal membrane oxygenation (ECMO) to stabilize patients preoperatively. This practice has led to controversy regarding whether the repair should be performed while the patient is on ECMO or after decannulation. This report details the authors' experience with repair of CDH on ECMO. ⋯ Additionally, four of the nine patients in group I required reexploration because of hemorrhage; this was not required for any patient in group II (P = .005). Although the survival rates differed, this may have been because of a bias in patient selection between the two groups. From these preliminary data, the authors conclude that repair of congenital diaphragmatic hernia on ECMO can be performed safely, with a minimum of hemorrhagic complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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Laparoscopic procedures requiring abdominal CO2 insufflation are applied with increasing frequency to the pediatric age group. Whereas the physiological effects accompanying insufflation have been studied in laboratory and clinical adult subjects, little is known of these effects in the juvenile subject. Young swine (weight, 10 to 12 kg, approximate age, 6 weeks) were subjected to abdominal CO2 insufflation at 10 and 15-mm Hg insufflation pressures (IP) to evaluate potential metabolic and hemodynamic effects. ⋯ End-tidal CO2 increased by 53% at 10 mm Hg IP, and by 68% at 15 mm Hg IP. Right atrial pressure did not increase significantly, and IVC pressure increased in proportion to the IP. Abdominal CO2 insufflation in this model produced marked acidemia, hypercapnia, decreased oxygenation, and increased exhaled CO2.(ABSTRACT TRUNCATED AT 250 WORDS)