ABSTRACT
We have experienced early extubation after 20 consecutive open heart surgeries for congenital heart disease between May 19 th and May 30 th this year. Eighteen of those 20 had the tracheal tube removed in the operating room immediately after operation. The reanlts were good and satisfactory. Two required postoperative ventilatory support for several hours at RICU. Sufentanil (Sufenta) 10-15 ug/kg was used intravenously as a major narcotic anesthetic for 18 podiatric patients and Fentanyl 50 ug/kg used for 2 adult Patients. The advantages of early extubation are as follows ; It is more physiologic, more comfortable, psychologically leas anxiety provoking for the patients and has less chance of pulmonary infection and less chance of ventilator mishaps arid it also shortens RICU stay and hospitalization. It is concluded that early extubation after open heart surgery for congenital heart disease has minimal risk and definite advantages in carefully selected patients.
Subject(s)
Adult , Humans , Anxiety , Fentanyl , Heart Defects, Congenital , Heart Diseases , Heart , Hospitalization , Operating Rooms , Sufentanil , Thoracic Surgery , Ventilators, MechanicalABSTRACT
Subclavian vein catheterization is a well estab1ished technique in adults for central venous pressure monitoring and the infusion of irritant solutions. Its use in small children is less common, preaumably because of technical difficulties in inserting the catheter and the disk of major complications. During cardiac surgery heparinization potentially adds to the risk of hematoma forma-tion. But it is often preferred becauae of the greater stability of the catheter on the anterior chest wall and allows a greater freedom of the neck and upper limb movement. We have experienced 62 open heart surgeries for congenital heart disease between April 14th and Oecember 31th 1986. In 47 children ranging in age from 11 months to 15 years, there was a high succes rate and no morbidity. It is concluded that infraclavicular subclavian vein catheterization is a useful means of measuring central venous presaure and establishing a central infusion line in children undergoing open heart surgery.
Subject(s)
Adult , Child , Humans , Catheterization , Catheters , Central Venous Pressure , Freedom , Heart , Heart Defects, Congenital , Hematoma , Heparin , Neck , Subclavian Vein , Thoracic Surgery , Thoracic Wall , Upper ExtremityABSTRACT
Myasthenia gravis is relatively common in young women and therefore sometimes associated with pregnancy. Since pregnancy influences the course of the myasthenia gravis, and the drugs used for its treatment may influence gestation, the obstetrical management of myas-thenic patient merits special consideration. In myasthenia gravis, it is generally thought that the anesthesia of chice is regional anesthesia during vaginal delivery and general anesthesia during Cesarian section. But in Cesarina section for a pregnant myasthenic with pulmonary disease, epidural or subarachnoid block may be preferable to avoid postoperative hazards. We performed epidural anesthesia with lidocaine in a 39-year-old elderly primigravida myasthenic with COPD and obtained good intra and postoperative results.
Subject(s)
Adult , Aged , Female , Humans , Pregnancy , Anesthesia , Anesthesia, Conduction , Anesthesia, Epidural , Anesthesia, General , Lidocaine , Lung Diseases , Myasthenia Gravis , Pulmonary Disease, Chronic ObstructiveABSTRACT
Bed-side measurement of Vd/Vt has not been used clinically, because the measurement of Pico2 in using the Bohr equation is complicated and a time-consuming test. A new, simplified and time-saving, bed-side calculation of Vd/Vt by using the Radford nomogram has been developed. In order to verify the method of calculated Vd/Vt, we compared the two methods(measured versus calculated Vd/Vt) in 20 open heart patients. Two methods had direct correlationship(y=0.95X+0.04) with r=0.864, and so the authors considered that the calculating method in the measurement of Vd/Vt is advantageous in clinical use.