Background: Congenital heart surgeries are associated with post-bypass renal and cardiac dysfunctions. The use of low-dose vasopressin has been found to be beneficial in adult cardiac surgeries. Objective: To assess the hemodynamic and renal effects of patients undergoing on-pump pediatric cardiac surgery under general anesthesia (GA) with low-dose vasopressin infusion. Design: Prospective randomized controlled study. Setting: Operation room and ICU, tertiary care teaching hospital. Patients: Fifty-five pediatric cardiac patients undergoing repair for congenital heart diseases (CHD). Interventions: Low-dose vasopressin infusion in the study group and placebo in the control group. Measurements and Main Results: Renal near-infrared spectroscopy (NIRS), serum NGAL, and inflammatory mediators—IL6 and IL8 along with other renal and hemodynamic parameters in the perioperative period were recorded. Diastolic blood pressure (DBP) and cardiac index were significantly higher in the vasopressin group. Inflammatory markers were significantly high in the immediate postoperative period in all patients which later stabilized in the next 48 h but showed similar trends in both groups. Low-dose vasopressin infusion did not improve either renal perfusion or function. The duration of mechanical ventilation and length of hospital stay, the incidence of AKI development, and transfusion requirements were marginally lower in the vasopressin group, although not significant. Conclusion: Low-dose vasopressin infusion improved hemodynamics and showed a decreased incidence of complications. However, it failed to show any benefit of renal function and overall outcome in pediatric cardiac surgery.

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Cardiac air embolism is common while undergoing cardiac surgeries as these require an opening of left-sided cardiac chambers, right-sided cardiac chambers, aorta or due to inadequate de-airing of a saphenous vein graft. Right coronary artery air embolism is one of the common cause of hemodynamic instability after coming off cardiopulmonary bypass. We discussed two cases in which the transesophageal echocardiography (TEE) helped in diagnosing right-coronary artery air embolism as the cause of sudden ST-segment elevation, hemodynamic instability, and right ventricular (RV) dysfunction.