Impact of chylothorax on the early post operative outcome after pediatric cardiovascular surgery

Chylothorax is the accumulation of chyle in the pleural cavity, which usually develops after disruption of the thoracic duct along its intra-thoracic route. In the majority of cases, this rupture is secondary to trauma [including cardio thoracic surgeries]. Chylothorax is a potentially serious complication after cardiovascular surgeries that require early diagnosis and adequate management. This study aims to determine the risk factors and the impact of chylothorax on the early postoperative course after pediatric cardiac surgery. A retrospective study of all cases complicated with chylothorax after pediatric cardiac surgery was conducted at King Abdulaziz Cardiac Center between January 2007 and December 2009. There were 1135 cases operated on during the study period. Of these, 57 cases [5%] were complicated by chylothorax in the postoperative period. Thirty patients [54%] were males, while 27 [47%] were females. Ages ranged from 4 to 2759 days. The most common surgeries complicated by chylothorax were the single ventricle repair surgeries [15 cases, 27%]; arch repairs [10 cases, 18%]; ventricular septal defect repairs [10 cases, 18%]; atrioventricular septal defect repairs [7 cases, 12%]; arterial switch repair [6 cases, 11%], and others [8 cases, 14%]. The intensive care unit [ICU] and the length of hospital stays were significantly longer in the chylothorax group. Additionally, some early postoperative parameters such as incidence of sepsis, ventilation time, and inotropes duration and number were higher in the chylothorax group. Chylothorax after pediatric cardiac surgery is not a rare complication. It occurs more commonly with single ventricle repair and aortic arch repair surgeries, and has a significant impact on the postoperative course and post operative morbidity

Chloral hydrate versus midazolam as sedative agents for diagnostic procedures in children

To compare sedation outcomes for chloral hydrate [CH] and midazolam [MD] as sedative agents for diagnostic procedures in children. A prospective, randomized, double-blinded study conducted between July 2005 and October 2006, at the Pediatric Day Care Unit [DCU], King Abdulaziz Medical City, Riyadh, Saudi Arabia. After meeting the inclusion criteria and getting informed consent, patients were randomized, given the study drug, and monitored for sedation outcomes. Two hundred and seventy-five patients who had 292 sedation sessions for diagnostic procedures were included in the study. Due to missing data, 286 sedations were included in the final analysis; 144 in the CH and 142 in the MD group. Both groups were comparable with respect to demographic and baseline characteristics. The CH compared to MD group, had a higher sedation success rate, shorter time to achieve sedation, shorter length of stay in DCU, and longer sedation duration. In both study groups, patients who required a second dose tended to be older and heavier. No major side effects were encountered. The CH group had a significantly higher mean sedation scores at 15, 30, 45, and 60 minutes. Chloral hydrate compared to MD, had a shorter time to achieve sedation, a higher success rate, less need for a second dose, and decreased the time spent in the DCU. Older and heavier patients are more likely to require a second dose of the study drug to be sedated

Effect of submersion injury on water safety practice after the event in children, Saudi Arabia

To bring to light issues surrounding water safety practices and the impact of such incidents on these practices in our community. We conducted a prospective observational study at King Abdul-Aziz Medical City, Riyadh, Kingdom of Saudi Arabia of all children <12 years of age presenting with submersion injury in the period between January 1999 through December 2004 noting the demographics and the pattern of water safety practices prior to and after event. A total of 29 patients were included. The majority of incidents took place in swimming pools. Water safety practices were lacking in most cases as evidenced by the fact that 87% of the victims were not properly supervised at the time of the event. None of swimming pools met the required safety regulations. Cardiopulmonary resuscitation knowledge was virtually nonexistent. The event did not have a positive impact on the water safety practices of the affected families. Submersion injury is also prevalent in land locked areas. Water safety practices are deficient in our community. Submersion injury was not enough to have a consistent positive impact on water safety practices of the affected families. Much can be carried out to improve water safety and save lives