Central venous catheterization for pressure monitoring and drug administration is often important in the anesthetic management of infants undergoing cardiovascular surgery. We examined the effects of patient age, weight, and central venous pressure and the experience of the anesthesiologist on the rate of successful catheterization and catheterization time of the internal jugular vein (IJV) in a prospective study. We studied 106 infants undergoing IJV catheterization for cardiovascular surgery over a 7-mo period at our institution. We catheterized the IJV by the high approach. The direct venipuncture or the Seldinger method was used according to the patient's weight. Overall successful catheterization rate was 97.2%, and the average catheterization time was 353 +/- 21 s (mean +/- SEM). Complications included arterial puncture in 12 cases (11.3%), hematoma formation in four cases (3.8%), and catheter malposition in two cases (1.9%), but pneumothorax was not observed. When a patient was younger than 3 mo or weighed less than 4.0 kg, successful catheterization rate decreased significantly to 81.3% and 78.6%, respectively. Catheterization time was inversely correlated with both age and weight, whereas central venous pressure did not affect either successful catheterization rate or catheterization time. We were unable to demonstrate that the experience of the anesthesiologist plays a significant role in the success or complication of the catheterization procedure. Our results indicate that IJV catheterization by the high approach is a reliable and useful technique in infants, and that the weight and age of the patient significantly influence the rate of successful catheterization.

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We evaluated the accuracy of fiberoptic catheter oximetry in the jugular bulb during conditions of normothermia, hemodilution, and hypothermia in 11 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB). An oximetry catheter was inserted into the right jugular bulb under general anesthesia, calibrated by the in vitro (n = 7) or in vivo (n = 4) mode. Jugular bulb oxygen saturation (SjO2) with the catheter oximeter was compared with a concurrent laboratory CO-oximeter value from a blood sample during surgery. Nasopharyngeal temperature (NPT) and hemoglobin concentration (Hb) were also measured. The oximetric catheter SjO2 correlated closely with the CO-oximeter determinations in both calibration modes (in vitro, r2 = 0.88; in vivo; r2 = 0.96). Data in the in vitro calibrated group were grouped into three conditions; 1) normothermia and no hemodilution, 2) normothermia and hemodilution, and 3) hypothermia and hemodilution, and showed good correlations between SjO2 values measured by the two methods (r2 = 0.90, r2 = 0.81, r2 = 0.79, respectively). The difference in SjO2 values by the two methods was not significantly affected by changes in NPT and Hb during CPB. In conclusion, the continuous SjO2 monitoring with catheter oximetry during CPB would be accurate and reliable under either calibration mode. Moderate hypothermia and hemodilution during CPB did not significantly influence the accuracy.

Twenty-eight patients undergoing cardiac surgery were prospectively studied and were assigned to two groups. The patients received 0.8-(Group L) or 2.0-fold (Group H) dose of protamine for the neutralization after cardiopulmonary bypass (CPB) which was determined by Hepcon HMS assay system in which the reagent chamber containing the concentration of protamine that completely neutralized the heparin had the shortest clotting time. Mean dose of protamine was 1.60 ± 0.50 mg kg −1 in Group L, and 3.56 ± 1.48 mg kg −1 , respectively. Activated clotting times (ACT) were comparable between the two groups through this study period. In Group H, platelet counts significantly decreased to 69% of that before protamine administration, and plasma platelet factor 4 level significantly increased to approximate 2-fold of that before protamine administration just after protamine administration, respectively. However, these phenomena were not observed in Group L. In addition, these hemostatic changes occurred transiently just after protamine administration. We conclude that the low-dose protamine may prevent transient platelet depletion following CPB. Low-dose protamine can neutralize anticoagulation effect of heparin sufficiently and may mitigate protamine-induced platelet dysfunction. Am.

SummaryTranscranial Doppler and continuous measurements of jugular venous oxygen saturation were used to monitor intra-operative cerebral haemodynamics in a patient with Takayasu's arteritis who underwent carotid revascularisation. These techniques were found to be of clinical value for detection of cerebral hypoperfusion and assessment of the effects of therapeutic intervention.