scholarly journals Pengelolaan Neuroanestesi pada Pasien dengan Pentalogy of Fallot

2020 ◽  
Vol 9 (2) ◽  
pp. 168-172
Author(s):  
Eka Satrio Putra ◽  
◽  
Retno Suryandari ◽  
Purwoko Purwoko ◽  
Ardana Tri Arianto ◽  
...  
Keyword(s):  
Heart Disease ◽  
Oxygen Saturation ◽  
Vital Signs ◽  
Oxygen Demand ◽  
Sudden Increase ◽  
Cyanotic Heart Disease ◽  
Rare Type ◽  
Normal Limits ◽  
End Tidal ◽  
The Brain

Pentalogy of Fallot (POF) is a rare type of cyanotic congenital heart defect with high risk of having cerebral abscesses as one of its complications. Cerebral abscesses are often found in cyanotic heart disease due to chronic hypoxia and hyperviscosity reduced microcirculatory flow to the brain. We report a 6-year-old boy, 14 kg body weight with multiple brain abscesses accompanied by Pentalogy of Fallot (POF) who undergone a craniotomy to evacuate the abscess. Preoperative physical examination found GCS E4V5M6, other vital signs within normal limits, preductal oxygen saturation 88%, post ductal oxygen saturation in supine position 84%. The I-II heart sounds are regular with grade 3 systolic murmur in the left parasternal third intercostal space and clubbing finger was found. The laboratory shows a hemoglobin value of 14.4gr%, hematocrit of 43%, leukocytosis 13,200/mm³. The goal of anesthesia in cyanotic heart disease is to maintain cardiac output by stabilize heart rate, contractility as well as preload, prevent the increase of PVR:SVR ratio and avoid hypercyanotic due to sudden increase in systemic oxygen demand. The choice of anesthetic agent must be based on the patient's physiology. Adequate rehydration before induction and use of mannitol diuretics can be considered to reduce hyperviscosity that decrease oxygen delivery to the brain. Increased intracranial pressure from ketamine can be reduced by hyperventilation, in conjunction to benzodiazepines and prevention of hypercapnia. Therefore, monitoring end tidal CO2 (ETCO2) needs to be done. This case report delineating the perioperative management of a 6 years old boy with POF underwent evacuation of cerebral abscesses, will highlight the importance of understanding the pathophysiology of POF and neuroanesthesia techniques in order to receive a good outcome.

Intranasal dexmedetomidine: the ideal drug for sedation in the pediatric echo lab?

2021 ◽  
pp. 1-5
Author(s):  
David E Saudek ◽  
Deborah Walbergh ◽  
Peter Bartz ◽  
Sara Shreve ◽  
Amy Schaal ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Disease ◽  
Chart Review ◽  
Chloral Hydrate ◽  
Vital Signs ◽  
Cyanotic Heart Disease ◽  
Historical Cohort ◽  
Safety And Efficacy ◽  
Attractive Option ◽  
The Ideal

Abstract Background: Intranasal dexmedetomidine is an attractive option for procedural sedation in pediatrics due to ease of administration and its relatively short half-life. This study sought to compare the safety and efficacy of intranasal dexmedetomidine to a historical cohort of pediatric patients sedated using chloral hydrate in a pediatric echo lab. Methods: Chart review was performed to compare patients sedated between September, 2017 and October, 2019 using chloral hydrate and intranasal dexmedetomidine. Vital signs, time to sedation, duration of sedation, need for second dose of medication, rate of failed sedation, and impact on vital signs were compared between groups. Subgroup analysis was performed for those with complex and cyanotic heart disease. Results: Chloral hydrate was used in 356 patients and intranasal dexmedetomidine in 376. Patient age, complexity of heart disease, and duration of sedation were similar. Rates of failed sedation were very low and similar. Average heart rate and minimum heart rate were lower for those receiving intranasal dexmedetomidine than chloral hydrate. Impact on vital signs was similar for those with complex and cyanotic heart disease. No adverse events occurred in either group. Conclusions: Sedation with intranasal dexmedetomidine is comparable to chloral hydrate in regards to safety and efficacy for children requiring echocardiography. Consistent with the mechanism of action, patients receiving intranasal dexmedetomidine have a lower heart rate without morbidity.

Sevoflurane Depresses Myocardial Contractility Less than Halothane during Induction of Anesthesia in Children

1996 ◽  
Vol 85 (6) ◽  
pp. 1260-1267. ◽  
Author(s):  
Robert S. Holzman ◽  
Mary E. van der Velde ◽  
Sarah J. Kaus ◽  
Simon C. Body ◽  
Steven D. Colan ◽  
...  
Keyword(s):  
Myocardial Contractility ◽  
Mechanical Energy ◽  
Vital Signs ◽  
Volatile Anesthetic ◽  
Wall Stress ◽  
Left Ventricular ◽  
Attractive Alternative ◽  
Inhalation Induction ◽  
Normal Limits ◽  
End Tidal

Background Cardiovascular stability is an important prerequisite for any new volatile anesthetic. We compared echocardiographically derived indices of myocardial contractility during inhalation induction with sevoflurane and halothane in children. Methods Twenty children were randomized to receive either halothane or sevoflurane for inhalation induction of anesthesia. No preoperative medications were given. Myocardial contractility was evaluated at baseline and at sevoflurane and halothane end-tidal concentrations of 1.0 minimum alveolar concentration (MAC) and 1.5 MAC. Results There were no differences between groups in patient age, sex, physical status, weight, or height. Equilibration times and MAC multiples of sevoflurane and halothane were comparable. Vital signs remained stable throughout the study. Left ventricular end-systolic meridional wall stress increased with halothane but remained unchanged with sevoflurane. Systemic vascular resistance decreased from baseline to 1 MAC and 1.5 MAC with sevoflurane. Halothane depressed contractility as assessed by the stress-velocity index and stress-shortening index, whereas contractility remained within normal limits with sevoflurane. Total minute stress and normalized total mechanical energy expenditure, measures of myocardial oxygen consumption, did not change with either agent. Conclusions Myocardial contractility was decreased less during inhalation induction of anesthesia with sevoflurane compared with halothane in children. Although the induction of anesthesia with sevoflurane or halothane was equally well tolerated, the preservation of myocardial contractility with sevoflurane makes it an attractive alternative for inducing anesthesia in children.

Comparative Effects of Halothane and Ketamine on Systemic Arterial Oxygen Saturation in Children with Cyanotic Heart Disease

1986 ◽  
Vol 65 (6) ◽  
pp. 666-668 ◽  
Author(s):  
William J. Greeley ◽  
Gerald A. Bushman ◽  
Deborah P. Davis ◽  
J Gerald Reves
Keyword(s):  
Heart Disease ◽  
Oxygen Saturation ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Cyanotic Heart Disease

Pulsus Alternans during General Anesthesia with Halothane

2000 ◽  
Vol 93 (1) ◽  
pp. 91-94 ◽  
Author(s):  
Mahmood Saghaei ◽  
Mojtaba Mortazavian
Keyword(s):  
Carbon Dioxide ◽  
Vital Signs ◽  
Pulse Amplitude ◽  
Normal Subjects ◽  
Spontaneous Respiration ◽  
Halothane Anesthesia ◽  
Normal Limits ◽  
Pulsus Alternans ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

Background Pulsus alternans is a classic type of abnormal pulse. It can be defined as a regular alternation of pulse amplitude in which runs of weak and strong beats follow each other alternatively without any change in cycle length. It may be a sign of severe decompensated congestive heart failure. The authors infrequently encountered some cases of pulsus alternans during halothane anesthesia with spontaneous respiration in otherwise normal subjects in association with high levels of end-tidal carbon dioxide. This study was conducted to determine if there is any relation between this phenomena and hypercapnia. Methods One hundred twenty patients undergoing elective lower extremity surgery were selected. Halothane was used for maintenance of anesthesia, and the patients were allowed to breath spontaneously. The occurrence of pulsus alternans was determined by plethysmographic display of pulse wave and then confirmed by palpation of the radial artery. Results Ten patients (8.3%) developed pulsus alternans together with elevated levels of end-tidal carbon dioxide (57 +/- 4 mmHg vs. 41 +/- 4 mmHg in patients without pulsus alternans [mean +/- SD]). The pulsus alternans disappeared after switching to controlled ventilation and 15-20% reduction in end-tidal carbon dioxide. During the period of pulsus alternans, vital signs and electrocardiography remained within normal limits. Conclusions There may be some relation between occurrence of pulsus alternans and hypercapnia during halothane anesthesia. Pulsus alternans occurs in a small fraction of spontaneously breathing, halothane-anesthetized patients. Although hypercapnia is clearly a factor, the mechanism of this phenomenon is unknown.

THE PLATELETS IN CYANOTIC CONGENITAL HEART DISEASE

PEDIATRICS ◽  
1968 ◽  
Vol 42 (4) ◽  
pp. 651-658
Author(s):  
Samuel Gross ◽  
Vicki Keefer ◽  
Jerome Liebman
Keyword(s):  
Heart Disease ◽  
Oxygen Saturation ◽  
Initial Response ◽  
Cyanotic Congenital Heart Disease ◽  
Cyanotic Heart Disease ◽  
Older Children ◽  
Normal Children ◽  
Platelet Counts ◽  
The Mean ◽  
Congenital Cyanotic Heart Disease

The mean platelet count in 102 children with congenital cyanotic heart disease was found to be 235,000/mm3 ± 1 S.D. of 85,000/mm3 as compared to 260,000 ± 70,000 in an age-matched group of normal children. In the cyanotic children, whose mean oxygen saturation was >80%, the mean platelet level was 315,000/mm3 as compared to 185,000/mm3 in the <60% oxygen saturation group. The platelet means were inversely related to the mean hemoglobins, such that the mean hemoglobin in the >80% oxygen saturation group was 13.2 gm/100 ml as compared to 17.2 in the <60% group. The age of the patient, and thus the duration of the disease, was also related to the platelet levels with significantly higher platelet counts in the children under 3 years of age. The mean age of the patients with platelet counts below 100,000/mm3 was 4.7 years as compared to a mean age of 2.8 years in the patients with platelet levels greater than 400,000/mm3. In addition, the older children had the highest hemoglobins and the lowest oxygen saturations. The inverse was true for the thrombocytotic individuals. The level of bound iron was not related to the platelet levels; nor were there any associated marrow or suspected capillary changes. It appears that the initial response to oxygen undersaturation is a platelet stimulation which subsequently results in underproduction as oxygen desaturation persists and worsens.

Thrombocytopaenia in cyanotic CHD

2020 ◽  
pp. 1-6
Author(s):  
Simona Danioth ◽  
Urs Schanz ◽  
Matthias Greutmann
Keyword(s):  
Platelet Count ◽  
Heart Disease ◽  
Haemoglobin Level ◽  
Oxygen Saturation ◽  
Heart Defects ◽  
Inverse Correlation ◽  
Rank Test ◽  
Cyanotic Heart Disease ◽  
Platelet Counts

Abstract Introduction: Thrombocytopaenia is common in adults with cyanotic heart disease. Our aim was to explore potential mechanisms for thrombocytopaenia in these vulnerable patients. Methods: Adults with cyanotic heart defects were identified from our clinical database. Haemoglobin levels, platelet counts, and resting oxygen saturations were determined at baseline and during follow-up. Associations between patient characteristics and cardiac physiology with these parameters at baseline and during follow-up were analysed using regression models. Survival estimates were determined by the Kaplan–Meier method. Results: We included 79 patients (mean age 32.2 ± 12.4, 48 (61%) Eisenmenger syndrome, 20 (25%) Down syndrome). Mean oxygen saturation was 84.1 ± 5.9%; 38 (48%) had thrombocytopaenia. There was a strong inverse correlation between platelet count and haemoglobin level (R = −0.655, R2 = 0.429, p < 0.0001) and a weaker but significant positive correlation between platelet count and oxygen saturation (R = 0.345, R2 = 0.119, p = 0.002). There was a significant inverse correlation between decrease in platelet count and increase in haemoglobin level during follow-up (R = −0.401, R2 = 0.161, p = 0.001) but not to changes in oxygen saturation (R = 0.043, R2 = 0.002, p = 0.726). Survival estimates were lower for patients with thrombocytopaenia at baseline (log-rank test p < 0.0001). Conclusions: Our findings suggest a direct inverse correlation between platelet counts and haemoglobin levels in adults with cyanotic heart disease. Further studies are required to explore the mechanisms of thrombocytopaenia in cyanotic heart disease and its potential role as an independent marker of risk.

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