Severe Reduction in End-Tidal PCO2 following Unilateral Pulmonary Artery Occlusion in a Child with Pulmonary Hypertension

Jl, Schuller; Jg, Bovill

doi:10.1213/00000539-198906000-00019

Cited by 4 publications

(3 citation statements)

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“…If this is accompanied by low blood pressure, the resultant low cerebral perfusion pressure (also known as transcranial pressure [TCP]) can increase the risk of brain injury. Therefore, as described by us and others[ 13 14 15 16 ] in our previous publications, we must increase the perfusion pressure by increasing the systemic blood pressure using a vasopressor (such as phenylephrine or norepinephrine in aliquots as we clamp SVC for a short duration). Now, it is easy to follow the systolic blood pressure (SBP) when monitoring beat-to-beat changes in arterial BP in response to the pressor administration.…”

Section: Techniquementioning

confidence: 99%

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An alternate technique of performing total cavopulmonary connection without cardiopulmonary bypass

Talwar,

Tiwari,

Sengupta

et al. 2023

Annals of Pediatric Cardiology

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Total cavopulmonary connection (Fontan) without using cardiopulmonary bypass (CPB) may be superior to Fontan on CPB. In the experience of many, a Fontan operation without CPB may be associated with a reduced need for inotropic support, improved outcomes in the postoperative phase including faster time to termination of mechanical ventilatory support, reduced intensive care unit stay, lower volume of pleural and peritoneal effusions, and decreased hospital stay, thereby rendering it more cost-effective. However, the operation is technically more difficult to perform than Fontan on CPB and requires significant modifications of surgical technique and alteration in overall management strategy. In this article, an alternative technique of performing total cavopulmonary connection without CPB is described. Its advantages are briefly discussed.

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Section: Techniquementioning

confidence: 99%

“…In addition, the aim should be also to maintain a lower CO 2 so that there is cerebral vasoconstriction and less blood flow to the brain with the result that there is less cerebral venous congestion when the SVC is clamped. [ 15 16 ]…”

Section: Techniquementioning

confidence: 99%

An alternate technique of performing total cavopulmonary connection without cardiopulmonary bypass

Talwar,

Tiwari,

Sengupta

et al. 2023

Annals of Pediatric Cardiology

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“…Any decrease in ETCO 2 values from baseline values indicate either decreased CO2 production due to decrease in metabolism secondary to hypothermia or due to hypoventilation or increase in right to left shunt as in spell. ETCO2 is more sensitive than pulse-oximeter with early detection of any change in ventilatory parameters 20,21 . The aim should be to maintain a lower CO 2 so that there is cerebral vasoconstriction and less blood flow to the brain with the result that there is less cerebral venous congestion when the SVC is clamped.…”

Section: Indicationsmentioning

confidence: 99%

Bidirectional superior cavo-pulmonary anastomosis without cardiopulmonary bypass

Talwar

Sharma

Kumar

et al. 2008

Indian J Thorac Cardiovasc Surg

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Monitoring during paediatric cardiac anaesthesia

Purday

1994

Can J Anaesth

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Monitoring of paediatric anaesthesia has become increasingly more complex in recent years (precordial, oesophageal or paratracheal). Specialized monitoring includes the monitoring of mixed venous oxygenation saturation (S~O2) which is being increasingly used within the critical care area. Transoesophageal echocardiography (TOE) has become accepted in adult cardiac surgery particularly in the fields of mitral valve repair and aortic root surgery, where it allows immediate assessment of the adequacy of repair. The place of TOE in congenital heart disease is now becoming more clearly defined. Cerebral function monitoring is an area of a great deal of research and several new monitoring methods are under review. The use of the thromboelastogram in monitoring coagulation has been found to decrease blood and fluid replacement during liver transplantation and its use during cardiac surgery is increasing. Other end organs that are affected by cardiopulmonary bypass (CPB) include the gut; liver and immune system, possibly leading to multi-organ failure in some cases, and interest is being shown in their monitoring.The purpose of this review is to present the recent publications relating to specific areas of both standard and specialized monitoring and indicate areas where these monitors may prove particularly useful to the practitioner involved in the care of paediatric cardiac patients. Routine monitoring ElectrocardiogramThe ECG displays the electrical activity of the heart. Abnormalities in the ECG can reflect alterations in rate or rhythm and changes in the ST segment may incidate underlying ischaemia. The normal ECG in childhood changes with age and shows several differences from the adult, particularly in the first few years of life where the right ventrical mass is dominant. There are several general changes that occur with increasing age (Table I). Heart rate (HR), frontal plane QRS vector (axis), PR interval, R wave heights and T waves are some of the factors that alter with age (Table II) and the reader is referred to a more specialized review for further information. 1,2 In adult cardiac surgery there has been investigation of perioperative myocardial ischaemia, its prognosis, and the best way of detecting it. 3,4 In children, however, there has been little work looking at the ST segment. Bell et al. ~ reported three cases of ST changes in neonates consistent with myocardial ischaemia. The first case involved a child of 26 wk who developed ST changes during awake laryngoscopy and lung retraction that were presumed to be related to myocardial hypoxia, although pulse oximetry readings were not mentioned. In the second case, ST changes improved on starting trinitroglycerine, isoproterenol and dopamine and in the third were related to ectiocardiographic changes. Cherian and Rao 6 associate the ST segment with the adequacy of coronary blood flow during the arterial switch operation for transposition. Observing leads I and V 5 for the left coronary and lead II for the right, greater than 1 mm elevation for more tha...

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Severe Reduction in End-Tidal PCO2 following Unilateral Pulmonary Artery Occlusion in a Child with Pulmonary Hypertension

Cited by 4 publications

References 0 publications

An alternate technique of performing total cavopulmonary connection without cardiopulmonary bypass

An alternate technique of performing total cavopulmonary connection without cardiopulmonary bypass

Bidirectional superior cavo-pulmonary anastomosis without cardiopulmonary bypass

Monitoring during paediatric cardiac anaesthesia

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