RESUMO
Early extubation after cardiac operations is an important aspect of fast-track cardiac anesthesia. In order to reduce or eliminate the adverse effects of prolonged ventilation, the concept of early extubation in pediatric patients has been examined at our institution. To allow rapid emergence from anesthesia post cardiac surgery, low-dose opioids, supplemented with continuous propofol infusion and low concentration of inhaled agent was used. Intercostal nerve block was used in thoracotomy operations. Contraindications to early extubation were: cardiopulmonary bypass [CPB] > 2.5 hours, hemodynamic instability, uncontrolled bleeding, severe pulmonary hypertension and congestive heart failure. Eighty-two consecutive patients were reviewed. The age range was 6 months - 14 years with mean of 3.3 years. Closed cardiac procedures were performed in 15 [18.3%] patients, and operations with Cardio-pulmonary bypass in 67 [81.7%] patients. No patient required re-intubation during the first 24 hours after operation. One patient was re-intubated 48 hours after extubation for sputum retention. There was no mortality, and the incidence of perioperative morbidity was low. Early extubation after pediatric cardiothoracic operations can be achieved safely, and is possible in the majority of such patients
RESUMO
Blunt chest trauma can result in a significant cardiothoracic injury. However, isolated tricuspid valve incompetence is an uncommon sequel of such injuries, and may be clinically silent. When symptoms arise, diagnosis is often made by transthoracic and/or transesophageal echocardiography in conjunction with color Doppler and occasionally cardiac catheterization. Treatment is essentially surgical in the form of tricuspid valve repair or replacement. We report here a case of a 32- year-old female, who presented with a recent onset of atrial fibrillation [AF] and a remote history of blunt trauma to her chest. Clinical examination revealed clinical signs of tricuspid regurgitation and right-sided heart failure. Echo-Doppler showed tricuspid valve regurgitation with ruptured chordae. Tricuspid valve replacement using mechanical prosthetic valve was done, as valve repair was not feasible