Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patie...Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patients. Design: Prospective randomized study. Setting: Tertiary care hospital. Participants: 60 children < 2 years age undergoing cardiac surgery. Interventions: The patients were randomized into 3 equal groups to receive 1.5-2.5 mg/kg iv ketamine (group K), 0.2-0.3 mg/kg iv etomidate (group E) or upto 8% sevoflurane (group S) as the induction agent. Hemodynamic parameters were noted before and after induction of anaesthesia utilizing a noninvasive cardiac monitor based on the model of electrical velocimetry. Measurements and Main Results: The demographic characteristics of the patients were similar in the three groups. The HR decreased in all groups, least in group E (P ≤ 0.01) but the MAP decreased only in group S (P ≤ 0.001). In group S, the stroke volume improved from 9 ± 3.2 ml to 10 ± 3.2 ml (P ≤ 0.05) and the stroke volume variation decreased from 25% ± 6.4% to 13% ± 6.2% (P ≤ 0.001). The stroke index and systemic arterial saturation improved in all groups (P ≤ 0.01). The cardiac index and index of contractility were unchanged. The transthoracic fluid content reduced in groups E and S, but did not change in group K (P ≤ 0.05). Conclusions: Etomidate appeared to provide the most stable conditions for induction of anesthesia in children undergoing cardiac surgery, followed by ketamine and sevoflurane.展开更多
Objective: For patients of TOF with pulmonary annular hypoplasia, reconstruction of right ventricular outflow tract (RVOT) often requires a trans annular patch (TAP). The present study aims to compare the outcomes of ...Objective: For patients of TOF with pulmonary annular hypoplasia, reconstruction of right ventricular outflow tract (RVOT) often requires a trans annular patch (TAP). The present study aims to compare the outcomes of TOF repair using Polytetrafluoroethylene (PTFE) patch versus autologous glutaraldehyde fixed pericardial patch for RVOT reconstruction. Materials and methods: 103 consecutive patients undergoing TOF repair in whom TAP was required were randomized into two groups: Group I (pericardial patch), Group II (PTFE patch). Postoperative outcomes in terms of postoperative heart rhythm, duration of mechanical ventilation, mediastinal and pleural drainage, length of stay in intensive care unit (ICU) and hospital mortality were assessed. A separate team of cardiologists independently evaluated pre- and post-operative gradients across the RVOT, degree of pulmonary insufficiency, right ventricular systolic function. Results: There were no significant differences between the two groups in terms of the incidence of postoperative arrhythmias, duration of mechanical ventilation, length of intensive care unit or hospital stay. The requirement of inotropes was no different in the PTFE patch group as compared with the pericardial patch group (16.84 ± 7.04 vs. 17.90 ± 6.71, median 19 vs. 20, p = 0.825). The re-exploration rate was higher in the PTFE group as compared with the pericardial patch group (6 vs. 1). Postoperative Echocar-diography revealed no differences in the RV systolic function between the two groups before discharge. Conclusion: In patients undergoing TOF repair, using a PTFE patch yields comparable results. However, the efficacy of PTFE will only be established once;mid-term and long-term results are available.展开更多
Objective: To compare the effect of a single induction dose of etomidate or ketamine on plasma cortisol levels in children with Tetralogy of Fallot (TOF) undergoing intra-cardiac repair on cardiopulmonary bypass (CPB)...Objective: To compare the effect of a single induction dose of etomidate or ketamine on plasma cortisol levels in children with Tetralogy of Fallot (TOF) undergoing intra-cardiac repair on cardiopulmonary bypass (CPB). Design: A prospective randomized trial. Setting: Cardiac center of a tertiary care hospital. Participants: Thirty children with TOF undergoing intra-cardiac repair on CPB. Interventions: After random allocation of the children into two groups, the children either received etomidate 0.2 mg/kg or ketamine 2 mg/kg intravenously for anesthetic induction along with fentanyl 2 mcg/kg and midazolam 100 mcg/kg. Endotracheal intubation was accomplished with rocuronium bromide in the dose of 1 mg/kg. Anesthesia was maintained with sevoflurane in air-oxygen, titrated to response and supplemental vecuronium bromide for muscle relaxation, fentanyl chloride for pain relief. Serum cortisol was measured on three occasions, at preinduction, at the end of surgery and at 24 hours postoperatively. Measurements and Main Results: Baseline plasma cortisol (Normal 5 - 25 mcg/dl) in the etomidate group (19.91 ± 3.51 mcg/dl) decreased significantly at the end of surgery (5.78 ± 2.0 mcg/dl) and rose to significantly higher than baseline values at 24 hours (27.31 ± 8.30 mcg/dl). The baseline cortisol levels in the ketamine group (20.91 ± 3.19 mcg/dl) increased significantly at the end of surgery (44.02 ± 5.49 mcg/dl) and remained significantly higher than baseline at 24hours (45.93 ± 3.05 mcg/dl). Plasma cortisol levels in the etomidate group at end of surgery, and at 24 hours post-operatively, were significantly lower than the ketamine group. Conclusions: This study shows that etomidate is a suitable and safe agent for suppression of the increase in serum cortisol associated with the use of CPB in children with TOF undergoing intra-cardiac repair.展开更多
Objective: To find out, whether the degenerative process of ascending aorta is limited to the aortic sinuses only or is extending to mid and distal ascending aorta of Bicuspid Aortic Valve patients. Method: A prospect...Objective: To find out, whether the degenerative process of ascending aorta is limited to the aortic sinuses only or is extending to mid and distal ascending aorta of Bicuspid Aortic Valve patients. Method: A prospective consecutive study on 25 patients of BAV (undergoing aortic valve with ± ascending aortic surgeries) was conducted from 1st Jan 2010 to 30th Dec 2011. Morphological and anatomical data of root and ascending aorta were recorded from echocardiography and computed tomography angiography. Intra-operatively, aortic tissue biopsy taken from three sites: sinus, mid, and distal ascending aorta. Histological evaluation of the aortic wall was based on criteria adapted from Schlatmann and Becker and from de Sa et al. The presence and degree of the 5 variables of degeneration were studied: Linear regression and correlation were used to get relationship between histopathological scoring (HPE-T) and aortic diameter for each site of ascending aorta. Results: Significant linear relation was found between aortic sinus diameter and HPE T score with R value = 0.590 (p value 0.001) and variance of 37.5%. Analysis suggests that HPE T Score = -5.139 + (0.188 x Ao. Sinus Diameter in mm). No significant linear relation could be established between mid and distal ascending aorta diameter and HPE T scoring. Conclusion: In BAV patient’s, a definite relationship between degenerative changes of aortic media and aortic diameter was found and was limited up to the sinus level only. Thus, the study reinforces the thought of replacing aortic sinus too while dealing with aortic valve, even without significant dilatation. By this aggressive management of aortic root, progression of aortic dilatation or dissection can be prevented in bicuspid aortic valve patients.展开更多
文摘Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patients. Design: Prospective randomized study. Setting: Tertiary care hospital. Participants: 60 children < 2 years age undergoing cardiac surgery. Interventions: The patients were randomized into 3 equal groups to receive 1.5-2.5 mg/kg iv ketamine (group K), 0.2-0.3 mg/kg iv etomidate (group E) or upto 8% sevoflurane (group S) as the induction agent. Hemodynamic parameters were noted before and after induction of anaesthesia utilizing a noninvasive cardiac monitor based on the model of electrical velocimetry. Measurements and Main Results: The demographic characteristics of the patients were similar in the three groups. The HR decreased in all groups, least in group E (P ≤ 0.01) but the MAP decreased only in group S (P ≤ 0.001). In group S, the stroke volume improved from 9 ± 3.2 ml to 10 ± 3.2 ml (P ≤ 0.05) and the stroke volume variation decreased from 25% ± 6.4% to 13% ± 6.2% (P ≤ 0.001). The stroke index and systemic arterial saturation improved in all groups (P ≤ 0.01). The cardiac index and index of contractility were unchanged. The transthoracic fluid content reduced in groups E and S, but did not change in group K (P ≤ 0.05). Conclusions: Etomidate appeared to provide the most stable conditions for induction of anesthesia in children undergoing cardiac surgery, followed by ketamine and sevoflurane.
文摘Objective: For patients of TOF with pulmonary annular hypoplasia, reconstruction of right ventricular outflow tract (RVOT) often requires a trans annular patch (TAP). The present study aims to compare the outcomes of TOF repair using Polytetrafluoroethylene (PTFE) patch versus autologous glutaraldehyde fixed pericardial patch for RVOT reconstruction. Materials and methods: 103 consecutive patients undergoing TOF repair in whom TAP was required were randomized into two groups: Group I (pericardial patch), Group II (PTFE patch). Postoperative outcomes in terms of postoperative heart rhythm, duration of mechanical ventilation, mediastinal and pleural drainage, length of stay in intensive care unit (ICU) and hospital mortality were assessed. A separate team of cardiologists independently evaluated pre- and post-operative gradients across the RVOT, degree of pulmonary insufficiency, right ventricular systolic function. Results: There were no significant differences between the two groups in terms of the incidence of postoperative arrhythmias, duration of mechanical ventilation, length of intensive care unit or hospital stay. The requirement of inotropes was no different in the PTFE patch group as compared with the pericardial patch group (16.84 ± 7.04 vs. 17.90 ± 6.71, median 19 vs. 20, p = 0.825). The re-exploration rate was higher in the PTFE group as compared with the pericardial patch group (6 vs. 1). Postoperative Echocar-diography revealed no differences in the RV systolic function between the two groups before discharge. Conclusion: In patients undergoing TOF repair, using a PTFE patch yields comparable results. However, the efficacy of PTFE will only be established once;mid-term and long-term results are available.
文摘Objective: To compare the effect of a single induction dose of etomidate or ketamine on plasma cortisol levels in children with Tetralogy of Fallot (TOF) undergoing intra-cardiac repair on cardiopulmonary bypass (CPB). Design: A prospective randomized trial. Setting: Cardiac center of a tertiary care hospital. Participants: Thirty children with TOF undergoing intra-cardiac repair on CPB. Interventions: After random allocation of the children into two groups, the children either received etomidate 0.2 mg/kg or ketamine 2 mg/kg intravenously for anesthetic induction along with fentanyl 2 mcg/kg and midazolam 100 mcg/kg. Endotracheal intubation was accomplished with rocuronium bromide in the dose of 1 mg/kg. Anesthesia was maintained with sevoflurane in air-oxygen, titrated to response and supplemental vecuronium bromide for muscle relaxation, fentanyl chloride for pain relief. Serum cortisol was measured on three occasions, at preinduction, at the end of surgery and at 24 hours postoperatively. Measurements and Main Results: Baseline plasma cortisol (Normal 5 - 25 mcg/dl) in the etomidate group (19.91 ± 3.51 mcg/dl) decreased significantly at the end of surgery (5.78 ± 2.0 mcg/dl) and rose to significantly higher than baseline values at 24 hours (27.31 ± 8.30 mcg/dl). The baseline cortisol levels in the ketamine group (20.91 ± 3.19 mcg/dl) increased significantly at the end of surgery (44.02 ± 5.49 mcg/dl) and remained significantly higher than baseline at 24hours (45.93 ± 3.05 mcg/dl). Plasma cortisol levels in the etomidate group at end of surgery, and at 24 hours post-operatively, were significantly lower than the ketamine group. Conclusions: This study shows that etomidate is a suitable and safe agent for suppression of the increase in serum cortisol associated with the use of CPB in children with TOF undergoing intra-cardiac repair.
文摘Objective: To find out, whether the degenerative process of ascending aorta is limited to the aortic sinuses only or is extending to mid and distal ascending aorta of Bicuspid Aortic Valve patients. Method: A prospective consecutive study on 25 patients of BAV (undergoing aortic valve with ± ascending aortic surgeries) was conducted from 1st Jan 2010 to 30th Dec 2011. Morphological and anatomical data of root and ascending aorta were recorded from echocardiography and computed tomography angiography. Intra-operatively, aortic tissue biopsy taken from three sites: sinus, mid, and distal ascending aorta. Histological evaluation of the aortic wall was based on criteria adapted from Schlatmann and Becker and from de Sa et al. The presence and degree of the 5 variables of degeneration were studied: Linear regression and correlation were used to get relationship between histopathological scoring (HPE-T) and aortic diameter for each site of ascending aorta. Results: Significant linear relation was found between aortic sinus diameter and HPE T score with R value = 0.590 (p value 0.001) and variance of 37.5%. Analysis suggests that HPE T Score = -5.139 + (0.188 x Ao. Sinus Diameter in mm). No significant linear relation could be established between mid and distal ascending aorta diameter and HPE T scoring. Conclusion: In BAV patient’s, a definite relationship between degenerative changes of aortic media and aortic diameter was found and was limited up to the sinus level only. Thus, the study reinforces the thought of replacing aortic sinus too while dealing with aortic valve, even without significant dilatation. By this aggressive management of aortic root, progression of aortic dilatation or dissection can be prevented in bicuspid aortic valve patients.
