RESUMEN
The induction and intubation characteristics of sevoflurane were studied prospectively in 23 children, aged 3 months to 6 years (mean 24 +/- 20.25), undergoing repair of congenital cardiac defects. After premedication with syrup chloral hydrate (75mg/kg orally), anaesthesia was induced with 8% sevoflurane and 50% nitrous oxide in oxygen. Nasal endotracheal intubation was performed once the pupils were small and central, without the use of neuromuscular blocking agents or opioids. Characteristics of induction and intubating conditions were recorded. Induction time (from application of face mask to loss of eyelash reflex) was 43.7 +/- 4.57 secs (mean +/- SD). Mean intubation time was 149.1 +/- 15.6 secs. Intubating conditions were excellent in 21 patients (91.3%) and good in 2 patients (80.7%). Haemodynamic parameters (heart rate, rhythm, and systolic blood pressure) were recorded at loss of eyelash reflex, immediately before intubation and at 1, 3 and 5 min after intubation. All children remained haemodynamically stable throughout induction and there were no adverse airway events.
RESUMEN
To compare the haemodynamic effects and intubating conditions of rocuronium and vecuronium, 20 patients of either sex with poor left ventricular function (ejection fraction <35%) scheduled for coronary artery bypass surgery were randomly divided into two equal groups. All patients were premedicated with lorazepam and morphine and induced with morphine, midazolam, thiopentone and either vecuronium (0.1 mg/kg) or rocuronium (0.6 mg/kg) as muscle relaxant. All patients were intubated after 3 minutes in the vecuronium group and 90 seconds in the rocuronium group by the same anaesthesiologist. Monitoring in all cases included neuromuscular (train of four- TOF), systemic and pulmonary arterial pressures, cardiac output and calculated haemodynamic variables. Demographic (age, sex and mean ejection fraction) and haemodynamic variables were comparable in both the groups. A significant suppression of the TOF in the vecuronium group was observed despite better intubating conditions in the rocuronium group. The heart rate at 3 minutes and mean arterial pressure at 1 minute was higher in the vecuronium group as compared to the rocuronium group. There were no other significant haemodynamic differences in both the groups. We conclude that rocuronium does provide better intubating conditions at 90 seconds than vecuronium at 3 minutes with no significant differences in the haemodynamic parameters between the two; however, the train of four response does not correlate with intubating conditions.
RESUMEN
Utility of intraoperative echocardiography (IOE) in perioperative management of congenital heart disease has been reported in literature. However, its consistent use as a monitoring tool has not yet been reported from our country. The aim of this study was to evaluate the role of routine use of IOE for intraoperative assessment of surgical repairs in terms of residual shunt, residual gradient, valvular insufficiency and ventricular function. Three hundred consecutive patients above 3 Kg body weight were included in this study. In 152 patients epicardial and in 148 patients transoesophageal echocardiography (TEE) was performed intraoperatively. Age ranged from 4 months to 52 years (median 5.8 yrs) and body weight from 3 Kg to 62 Kg (Median 12 Kg). IOE Doppler and Doppler colour flow imaging studies were performed before cardiopulmonary bypass (CPB) whenever feasible and after CPB in all patients. Pre-bypass examination yielded additional information in 17 (5.6%) patients. In 9 (3%) such patients it had an impact on surgery. In post CPB IOE studies, surgery was found to be 'perfect' in 210 (70%) patients and 'acceptable' residual defects in 70 (23.3%) patients. In 20 (6.6%) cases post CPB IOE found surgical repair 'unacceptable'. Ten of these patients required immediate surgical revision with excellent outcome, thus saving them from late reoperation or postoperative complications. No short term complications were encountered relating to the procedure. We conclude that intraoperative echocardiography is an inexpensive, accurate, valuable and safe addition to the perioperative care of patients and should be mandatory during all corrective surgical procedures for congenital heart disease. It is especially applicable in our country where the costs of reoperation for residual defects are prohibitive.