| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2001;20:114-119
© 2001 Elsevier Science NL
The Children's Mercy Hospital, University of Missouri-Kanas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, USA
Received 8 October 2000; received in revised form 28 March 2001; accepted 6 April 2001.
Corresponding author. Tel.: +1-816-234-3580; fax: +1-816-460-1012
e-mail: glofland{at}cmh.edu
Objective: Positive pressure ventilation is known to have a deleterious effect on pulmonary blood flow in patients with Fontan physiology. We evaluated the hemodynamic effects of pain free, spontaneous, non-positive pressure ventilation in patients undergoing Fontan staging procedures or completion. Fontan procedures, with creation of low pressure passive pulmonary circulation. Methods: Between May 1997 and May 1999 50 consecutive patients undergoing either bi-directional Glenn (BDG, n=23) or completion Fontan (n=27), were managed with early extubation. Anaesthetic management included continuous narcotics, caudal block, epidural block, or hyperbaric spinal. Post-operative management included low dose dopamine (3 mcg/kg per min), nitro-glycerine (0.3 mcg/kg per min) and nitroprusside (0.3 mcg/kg per min). Post-operative management was identical for all patients. Twelve patients were randomly selected to undergo continuous cardiac output and cardiac index (CI) determinations utilizing extra vascular Doppler probes placed on the ascending aorta, allowing for continuous aortic diameter and Doppler wave form velocity recordings. All patients were extubated either in the operating room or within one hour post-operatively. There were no deaths and no complications in the series. Mean length of stay (LOS) for BDG was 4.3±0.5 days. Mean LOS for Fontan patients was 11±4 days. Results: Mean pulmonary artery pressure (MPAP) fell from 19±3.464 pre-extubation to 14±3.271 immediately post-extubation, 13.2±2.261 6 h post-extubation, and 11.7±2.146 12 h post-extubation. All decreases in MPAP post-extubation were significant (P=<0.05). CI pre-extubation was 3.25±1.09, immediately post-extubation 5.05±1.297, 12 h post-extubation 6.225±1.19. All increases in CI post-extubation were significant (P=<0.05). Conclusion: Resumption of pain free, spontaneous, non-positive pressure ventilation enhances hemodynamic performance in patients with Fontan circulation and clearly improves outcome.
Key Words: Bi-directional Glenn shunt • Fontan
This article has been cited by other articles:
|
|
 |
|
  D. L.S. Morales, K. E. Carberry, J. S. Heinle, E. D. McKenzie, C. D. Fraser Jr, and L. K. Diaz Extubation in the operating room after Fontan's procedure: effect on practice and outcomes. Ann. Thorac. Surg., August 1, 2008; 86(2): 576 - 581. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J.C. Mittnacht, M. Thanjan, S. Srivastava, U. Joashi, C. Bodian, S. Hossain, N. Kin, I. Hollinger, and K. Nguyen Extubation in the operating room after congenital heart surgery in children J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 88 - 93. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. T. Lovell Anaesthetic implications of grown-up congenital heart disease Br. J. Anaesth., July 1, 2004; 93(1): 129 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Motta, E. Mossad, and R. Savage Right Ventricular Exclusion Surgery for Arrhythmogenic Right Ventricular Dysplasia with Cardiomyopathy Anesth. Analg., June 1, 2003; 96(6): 1598 - 1602. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
