Background:Prolonged preoperative fasting can cause hypoglycemia,hyperglycemia,and intravascular volume depletion in children.We aimed to examine whether prolonged preoperative fasting is associated with in-hospital m...Background:Prolonged preoperative fasting can cause hypoglycemia,hyperglycemia,and intravascular volume depletion in children.We aimed to examine whether prolonged preoperative fasting is associated with in-hospital mortality and other morbidities in pediatric cardiothoracic surgery.Methods:This retrospective cohort study included children aged 0–3 years who underwent cardiac surgery between July 2014 and October 2020.The patient demographic data,surgery-related and anesthesia-related factors,and postoperative outcomes,including hypoglycemia,hyperglycemia,sepsis,length of intensive care unit stay,and in-hospital mortality,were recorded.The main exposure and outcome variables were prolonged fasting and time-to-death after surgery,respectively.The associations between prolonged fasting and perioperative death were analyzed using multivariate Cox regression analysis.Results:In total,402 patients were recruited.The incidence of perioperative mortality was 21%(85/402).The proportion of perioperative deaths was significantly higher in the prolonged fasting group than that in the normal fasting group.The proportion of postoperative bacteremia and hypoglycemia was significantly higher in the very prolonged fasting group than that in the prolonged fasting group.After adjusting for preoperative conditions and anesthesia-and surgery-related factors,preoperative prolonged fasting>14.4 h was significantly associated with time-to-death(HR[95%CI]:2.2[1.2,3.9],p=0.036).The 30-day survival rates of fasting time>14.4 h,9.25–14.4 h,and<9.25 h were 0.67(0.55,0.81),0.79(0.72,0.87),and 0.85(0.79,0.91),respectively.Conclusions:Preoperative fasting of more than 14.4 h was associated with a two-fold increase in the hazard rate of time-to-death in children who underwent cardiac surgery.展开更多
Introduction:With the continuous progress being made in medicine and surgery,increasingly more advanced technology and monitoring equipment are being used in anesthesia,end-tidal carbon dioxide(PETCO_(2))monitoring re...Introduction:With the continuous progress being made in medicine and surgery,increasingly more advanced technology and monitoring equipment are being used in anesthesia,end-tidal carbon dioxide(PETCO_(2))monitoring revealed serious complications of cardiothoracic surgery.Case presentation:A 3-year-old boy with a body weight of 15 kg presented with a>1-month history of a heart murmur.At the moment of arterial catheter ligation,the PETCO_(2) decreased from 37 to 15 mmHg,while the blood pressure,heart rate,and airway resistance did not change significantly.After re-separation of the ligation catheter,the surgeons carefully exposed the ductus and left pulmonary artery again and ligated the ductus arteriosus.Conclusion:This case suggests that PETCO_(2) monitoring reflects the circulatory status and pulmonary blood flow.展开更多
基金Funding Statement:This study was funded by the Faculty of Medicine,Prince of Songkla University,Hat Yai,Songkhla,Thailand.L.R.received a grant amount of฿0 in May 2020(Grant No.62-463-8-3http://medinfo.psu.ac.th/).
文摘Background:Prolonged preoperative fasting can cause hypoglycemia,hyperglycemia,and intravascular volume depletion in children.We aimed to examine whether prolonged preoperative fasting is associated with in-hospital mortality and other morbidities in pediatric cardiothoracic surgery.Methods:This retrospective cohort study included children aged 0–3 years who underwent cardiac surgery between July 2014 and October 2020.The patient demographic data,surgery-related and anesthesia-related factors,and postoperative outcomes,including hypoglycemia,hyperglycemia,sepsis,length of intensive care unit stay,and in-hospital mortality,were recorded.The main exposure and outcome variables were prolonged fasting and time-to-death after surgery,respectively.The associations between prolonged fasting and perioperative death were analyzed using multivariate Cox regression analysis.Results:In total,402 patients were recruited.The incidence of perioperative mortality was 21%(85/402).The proportion of perioperative deaths was significantly higher in the prolonged fasting group than that in the normal fasting group.The proportion of postoperative bacteremia and hypoglycemia was significantly higher in the very prolonged fasting group than that in the prolonged fasting group.After adjusting for preoperative conditions and anesthesia-and surgery-related factors,preoperative prolonged fasting>14.4 h was significantly associated with time-to-death(HR[95%CI]:2.2[1.2,3.9],p=0.036).The 30-day survival rates of fasting time>14.4 h,9.25–14.4 h,and<9.25 h were 0.67(0.55,0.81),0.79(0.72,0.87),and 0.85(0.79,0.91),respectively.Conclusions:Preoperative fasting of more than 14.4 h was associated with a two-fold increase in the hazard rate of time-to-death in children who underwent cardiac surgery.
文摘Introduction:With the continuous progress being made in medicine and surgery,increasingly more advanced technology and monitoring equipment are being used in anesthesia,end-tidal carbon dioxide(PETCO_(2))monitoring revealed serious complications of cardiothoracic surgery.Case presentation:A 3-year-old boy with a body weight of 15 kg presented with a>1-month history of a heart murmur.At the moment of arterial catheter ligation,the PETCO_(2) decreased from 37 to 15 mmHg,while the blood pressure,heart rate,and airway resistance did not change significantly.After re-separation of the ligation catheter,the surgeons carefully exposed the ductus and left pulmonary artery again and ligated the ductus arteriosus.Conclusion:This case suggests that PETCO_(2) monitoring reflects the circulatory status and pulmonary blood flow.
