Kyobu geka. The Japanese journal of thoracic surgery
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Dexmedetomidine hydrochloride (DEX) is a newly developed alpha-2 adrenergic agonist sedative and has been shown to be effective in post-surgical patients, providing not only unique sedation but also stabilization of hemodynamic and respiratory function. We investigated the hemodynamic and respiratory effects and efficacy of DEX in 84 consecutive patients (age <6 months: 18, 6-12 months: 13, 1-3 years: 29, 4-9 years: 18, >10 years: 5, male:female = 44:40) who were sedated by DEX in combination with a small dose of midazolam and morphine. DEX was commenced at an initial dose of 0.7 microg/kg/hr during surgery, approximately 1 hour prior to transfer to the intensive care unit (ICU). ⋯ There were no adverse events related to DEX administration. Moreover, junctional ectopic tachycardia (JET) and severe pulmonary hypertension (PH) leading to clinical deterioration, which are the major causes of postoperative morbidity in pediatric cardiac surgery, occurred at a low incidence in this series. Our DEX protocol provided 1) satisfactory postoperative sedation without compromising hemodynamics and respiration, and 2) prevention and amelioration of postoperative morbidity caused by sympathomimetic stimulation, in pediatric cardiac surgery.
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A 28-years-old woman living in Japan who was diagnosed as atrial septal defect from the childhood period was admitted for exacerbation of the congestive heart failure with the renal insufficiency. Immediately, hemodialysis was established, but her platelet count tended to decrease, and she was found to have antibodies positive for type II heparin-induced thrombocytopenia (HIT). About anticoagulation during cardiopulmonary bypass (CPB), activated clotting time (ACT) was maintained than 400 seconds, using the continuance dosage together with the bolus dosage of argatroban. ⋯ After that the operation was performed with no problem. No HIT related complications occurred in the postoperative period. And regular hemodialysis has been performed with argatroban for anticoagulation even today.
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A 35-day-old female was referred to our department because of congenital chylothorax. Medical treatment with dietary restriction was undertaken for 5 weeks without resolution of the effusion. A video-assisted thoracic surgery was performed. ⋯ The postoperative course was satisfactory. She was discharged with resolution of the effusion. Video-assisted thoracic surgery offers an effective means of treating chylothorax.
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We used percutaneous cardiopulmonary support (PCPS) and beating heart hemostasis with a balloon technique to resuscitate an 80-year-old woman who had been stabbed in the chest with pruning shears. She developed pulseless tamponade while waiting for surgery. Resuscitative thoracotomy was impossible in the emergency room due to the lack of appropriate equipment. ⋯ The stab wound in the right ventricle was temporarily controlled with a urinary balloon catheter placed through the defect, and was repaired on the heart continued to beat She recovered from the fatal event without neurological impairment. PCPS is generally contraindicated for traumatic cases because of bleeding complications. However, it plays an important role as a life-saving procedure when emergency room thoracotomy is impossible.
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A 53-year-old woman with a double, double, double (DDD) pacemaker due to complete atrioventricular block was admitted to our hospital with a diagnosis of congestive heart failure. At the time of admission, she was in a hypoxic state with cyanosis and clubbed finger. The ultrasonic cardiogram showed a severe degree of tricuspid valve regurgitation and a thin left ventricular septal wall. ⋯ PFO closure and tricuspid valve annuloplasty (DeVega method) were performed. Following surgery, the patient's hypoxemia improved and the cyanosis disappeared. The patient was discharged 37 days after the operation.