Continual infusion of intrathecal baclofen [ITB]: long term effect on spasticity

Spasticity is a disorder of muscular function causing muscular tightness or spasm which occurs when there is damage to the central nervous system whether it is of spinal cord or brain origin. This insult could be either pathological or traumatic. Thirty-three patients had intrathecal Baclofen pumps implanted for severe spasticity. These patients either did not respond to or tolerate oral medications. All patients showed significant improvement in their spasms following the procedure. Improvement was noted not only in spasticity, but also in pain, management of sleep disturbance, activities of daily living, indoor and outdoor mobility and behavior. The number of complications was acceptable, and generally were not lifethreatening. Infection was the significant complication in two patients and this led to explantation of their pumps. Patient satisfaction was very high and was related to improvement in the quality of life for the patients

Total correction of tetralogy of fallot

Records of 165 patients who underwent total correction for Tetralogy of Fallot were analysed for early postoperative morbidity and mortality in the Intensive Care Unit. Eighty three patients [50.3%] had one or more pulmonary complications; 18 [10.9%] developed an infection; 10 [6%] developed acute renal failure requiring peritoneal dialysis; 9 [5.5%] required Total Parenteral Nutrition; there was no intraoperative death, but 6 patients [3.5%] died in the Intensive Care Unit, 4 of them aged 24 months [Group II]. Patients with a bypass time > 120 minutes had significantly more pulmonary complications [63.8%], compared to those < = 120 minutes [34.4%]; the longer bypass time group had significantly more pulmonary complications [78%] in patients aged < = 24 months at surgery compared to those aged > 24 months [50%]

Supportive and emergency use of prostaglandin in the neonate with congenital heart disease

A retrospective study of 28 neonates, admitted as emergencies with hypoxia due to inadequate pulmonary blood flow caused by congenital lesions in the pulmonary and / or tricuspid valves, showed a marked improvement in the degree of oxygenation after treatment with Prostaglandin E [1] [PGE [1]] infusion. The side effects related to the PGE [1] administration were observed, and were easily managed. The study demonstrates the efficacy of PGE [1] in maintaining the patency of the ductus arteriosus; we therefore propose that this drug should be used, though with caution, routinely in peripheral hospitals before such patients are transferred to specialised centres for further diagnostic and therapeutic intervention

Anesthetic management of patients with congenital heart disease coming for non-cardiac surgery

Anesthetic management for children with congenital heart disease depends principally on the understanding of the individual pathophysiological effect of the lesion, the anticipation of changes which could occur during anesthetic drugs administration, and the physiological manipulation which can be applied during anesthesia

Early postoperative mortality and morbidity after surgical repair of isolated congenital ventricular septal defect

During a 3-year period at the Riyadh Armed Forces Hospital, 128 patients under 12 years of age had elective surgical repair as the treatment of choice of isolated congenital ventricular septal defect [VSD]. The early postoperative mortality and morbidity during the period of stay in the intensive care unit [ICU] is reviewed retrospectively. Morbidity was assessed by the incidence of renal failure, pulmonary complications and recorded infection. The overall mean [ +/- SD] length of ICU stay was 4.7 +/- 7.8 days. Forty-nine patients [38%] had one or more pulmonary complications; infection was recorded in eight patients [6%]. There were no patients who developed renal failure and no deaths. Patients aged 12 months, despite a lower mean pulmonary vascular resistance. Fifty [39%] patients [Group A] who had VSD repair after deep hypothermia by surface cooling and circulatory arrest were significantly younger, had a significantly higher rate of pulmonary complications, with more recorded infection and a longer mean length of stay than the 78 patients [61%] who did not have surface cooling and circulatory arrest [Group B]. Subdivision of Groups A and B into age subgroups 12 months at surgery confirmed that patient age was an important prognosticator of early postoperative morbidity, whether deep hypothermia by surface cooling and circulatory arrest was used or not