Levosimendan is better than dobutamine for treatment of pulmonary hypertension of children undergoing cardiac surgery.

Background Increased lung water and the resultant atelectasis are significant pulmonary complications after cardiopulmonary bypass (CPB) in children undergoing cardiac surgery; these complications are observed after CPB than after anaesthesia alone. Ultrafiltration has been shown to decrease total body water and postoperative blood loss and improve the alveolar to arterial oxygen gradient and pulmonary compliance. This study investigated whether conventional ultrafiltration during CPB in paediatric heart surgeries influences post-bypass extravascular lung water (EVLW) assessed by lung ultrasound (LUS). Methods This randomized controlled study included 60 patients with congenital heart disease (ASA II-III), aged 1 to 48 months, with a body weight > 3 kg. Conventional ultrafiltration targeting a haematocrit (HCT) level of 28% was performed on the ultrafiltration group, while the control group did not receive ultrafiltration. LUS scores were recorded at baseline and at the end of surgery. The PaO2/FiO2 ratio (arterial oxygen tension divided by the fraction of inspired oxygen), urine output, and haemodynamic parameters were also recorded. Results LUS scores were comparable between the two groups both at baseline ( p = 0.92) and at the end of surgery ( p = 0.95); however, within the same group, the scores at the end of surgery significantly differed from their baseline values in both the ultrafiltration ( p = 0.01) and non-ultrafiltration groups ( p = 0.02). The baseline PaO2/FiO2 ratio was comparable between both groups. at the end of surgery, The PaO2/FiO2 ratio increased in the ultrafiltration group compared to that in the non-ultrafiltration group, albeit insignificant ( p = 0.16). no correlation between the PaO2/FiO2 ratio and LUS score was found at baseline (r = − 0.21, p = 0.31). On the other hand, post-surgical measurements were negatively correlated (r = − 0.41, p = 0.045). Conclusion Conventional ultrafiltration did not alter the EVLW when assessed by LUS and oxygenation state. Similarly, ultrafiltration did not affect the urea and creatinine levels, intensive care unit (ICU) stays, ventilation days, or mortality. Trial registration Clinicaltrials.gov Identifier: NCT03146143 registered on 29-April-2017.

Background: Postoperative pain management after pacemaker insertion routinely uses either opioid agents, nonsteroid anti-inflammatory drugs, or paracetamol. There has been increased interest in opioidsparing multimodal pain management to minimize postoperative narcotic use. This study aims to assess postoperative pain control and opioid consumption provided by pectoral nerve blocks (PECs) versus standard postoperative pain control in pediatric patients after transvenous subpectoral pacemaker insertion.Method: in this randomized controlled study, forty pediatric patients presented for transvenous subpectoral pacemaker insertion, with either congenital or post-operative complete heart block(CHB). :Patients were randomly assigned into two groups according to the method of perioperative pain management, Group C (control) received conventional analgesic care without any block and Group P (pectoral) received PECs. Demographics, procedural variables, postoperative pain, and postoperative opioid usage were compared between the two groups.Results:: Intra-procedure, pectoral nerve blocks reduced cumulative dose of fentanyl and atracurium with better hemodynamic profile and longer procedure time. Post-procedure, pectoral nerve blocks reduced postprocedural pain scores, which was reflected in later first call for rescue analgesia, and lower postoperative morphine consumption, and did not increase rates of complications in children who underwent transvenous subpectoral pacemaker insertion. Conclusion:Ultrasound guided PECs have a good intraoperative hemodynamic profile, reduce postoperative pain scores, and lower total opioid usage in children who underwent transvenous subpectoral pacemaker placement.