Standard digit-based versus 90° rotation technique for supraglottic airway device insertion: a meta-analysis of randomized controlled trials / 대한마취과학회지

Background@#Prompt insertion and placement of supraglottic airway (SGA) devices in the correct position are required to secure the airway. This meta-analysis was performed to validate the usefulness of the 90° rotation technique as compared with the standard digit-based technique for the insertion of SGA devices in anesthetized patients in terms of insertion success rate, insertion time, and postoperative complications. @*Methods@#A literature search of PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science was conducted. Randomized controlled trials, without limitations on publication period, language, journal, or region, until July 2021, that compared the 90° rotation and the standard digit-based techniques for insertion of SGA devices in anesthetized patients were included. @*Results@#The first-attempt (risk ratio [RR]: 1.16, 95% CI [1.09, 1.25], P < 0.001) and overall success rates (RR: 1.06, 95% CI [1.03, 1.09], P < 0.001) were significantly higher in the 90° rotation group. The insertion time was shorter in the 90° rotation group (mean difference: −4.42 s, 95% CI [−6.70, −2.15 s], P < 0.001). The incidences of postoperative sore throat (RR: 0.63, 95% CI [0.49, 0.83], P < 0.001) and blood staining (RR: 0.28, 95% CI [0.20, 0.39], P < 0.001) were lower in the 90° rotation group. @*Conclusions@#The use of the 90° rotation technique increases the success rate of SGA device insertion and decreases postoperative complications as compared with that of the standard digit-based technique in anesthetized patients.

Reliability and validity of Korean version of modified: Yale preoperative anxiety scale

PURPOSE: The modified Yale Preoperative Anxiety Scale (mYPAS) was developed for evaluating the level of preoperative anxiety in children. The purpose of this study was to develop a Korean version of the mYPAS (K-mYPAS) and to establish its validity and reliability based on the Korean preoperative pediatric patients. METHODS: K-mYPAS was made through stringent back-translation procedure. Total enrolled 102 patients answered questionnaires of Korean version of State-Trait Anxiety Inventory for Children (K-STAIC), and were videotaped for 2 to 5 minutes before induction of anesthesia. Three observers of experienced psychiatrist, surgeon, and nurse analyzed videotape with K-mYPAS comparing to K-STAIC. The inter- and intraobservers reliability, concurrent and construct validity, sensitivity, specificity, and predictive value were analyzed. RESULTS: The value of Cronbach alpha for interobservers reliability was 0.939 and intraobserver reliability was statistically significant (P < 0.001). Concurrent and construct validity were also statistically significant (P < 0.001 and P < 0.001, respectively). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 81.3%, 91.4%, 81.3%, 91.4%, and 88.2%, respectively. CONCLUSION: The K-mYPAS had good psychometric properties and can be used as a reliable and valid instrument for the assessment of preoperative anxiety in children.

Remifentanil dose for laryngeal mask airway insertion with a single standard dose of propofol during emergency airway management in elderly patients / 대한마취과학회지

BACKGROUND: This study determined the dose of remifentanil to use during insertion of a Classic(TM) laryngeal mask airway (LMA, The Laryngeal Mask Co., Nicosia, Cyprus) in elderly patients during emergency airway management when combined with a single dose of propofol. METHODS: Patients aged 65-80 years were enrolled. Anesthesia was induced with propofol 1 mg/kg, and then a blinded dose of remifentanil was infused over 30 s after confirming the patient's loss of consciousness. The dose of remifentanil was determined using Dixon's up-and-down method, starting at 0.5 microg/kg (a step size of 0.1 microg/kg). Insertion of the LMA was attempted 60 s after loss of consciousness. RESULTS: In total, 23 patients were recruited and the mean age +/- standard deviation was 72 +/- 3 years. The effective dose for successful LMA insertion in 50% of the patients (ED50) was 0.20 +/- 0.05 microg/kg. No patient needed more than 0.3 microg/kg. CONCLUSIONS: Remifentanil 0.20 +/- 0.05 microg/kg with propofol 1 mg/kg resulted in excellent LMA insertion in 50% of elderly patients without significant hemodynamic changes during emergency airway management.

Sevoflurane versus propofol for interventional neuroradiology: a comparison of the maintenance and recovery profiles at comparable depths of anesthesia / 대한마취과학회지

BACKGROUND: Sevoflurane and propofol are used widely for interventional neuroradiology (INR). Using the bispectral index (BIS), we compared the clinical properties of sevoflurane and propofol anesthesia in patients undergoing INR at comparable depths of anesthesia. METHODS: The patients were allocated randomly into two groups. The sevoflurane group received propofol (1.5 mg/kg), alfentanil (5 microg/kg), and rocuronium (0.6 mg/kg) for induction, and the propofol group was induced with a target effect-site concentration of propofol (4 microg/ml), alfentanil (5 microg/kg), and rocuronium (0.6 mg/kg). After intubation, anesthesia was maintained with sevoflurane or propofol with 67% nitrous oxide in 33% oxygen. Sevoflurane and propofol concentrations were titrated to maintain the BIS at 50-60. Phenylephrine or opioid was used to maintain the mean arterial pressure within 20% of the baseline values. The amounts of phenylephrine or alfentanil used, the number of patients showing movement during the procedure, and the recovery times were recorded. RESULTS: Compared to the propofol group, the sevoflurane group showed faster recovery in spontaneous ventilation, eye opening, extubation, and orientation (4 vs. 7 min, 7 vs. 9 min, 8 vs. 10 min, 10 vs. 14 min, respectively; P < 0.01). In the propofol group, significantly greater amounts phenylephrine were used (P < 0.05), and more patients moved during the procedure (P < 0.05). CONCLUSIONS: The use of sevoflurane in maintaining anesthesia during INR was associated with faster recovery, less patient movement during the procedure, and a more stable hemodynamic response when compared to propofol.

Gender difference and change of alpha1-adrenoceptors in the distal mesenteric arteries of streptozotocin-induced diabetic rats / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the gender-related changes in the function and distribution of alpha1-adrenoceptors in the distal mesenteric artery of streptozotocin (STZ)-induced diabetic rats at the level of alpha1-adrenoceptor subtypes. METHODS: Diabetes was induced by intravenous injection of STZ in a dose of 60 mg/kg through the tail vein in 8 week-old male or female Sprague-Dawley rats (n = 13/group). Age-matched normal rats (n = 15) were used as a control group. Four weeks after STZ injection, the change in mean arterial pressure caused by a 45degrees tilting was recorded. The alpha1-adrenoceptor subtypes mediating contractions of the distal mesenteric artery were investigated using the agonist, phenylephrine as well as subtype-selective antagonists including prazocin, 5-methylurapidil, and BMY 7378. The expression of alpha1-adrenoceptor subtypes of each artery was examined by immunofluorescence staining and western blotting using subtype selective antibodies. RESULTS: Compared with normal male rats, the contractile response to phenylephrine was decreased in the distal mesenteric artery in normal female rats. Moreover, a decrease in contractile force was observed in STZ-induced diabetic rats compared with age-matched controls. Western blotting revealed that there was the difference between normal male and female rats in manifestation of the alpha1D-adrenoceptor. In STZ-induced male and female diabetic rats, all alpha1-adrenoceptor subtypes were decreased in distal mesenteric arteries, compared with normal rats. CONCLUSIONS: There was the gender-related functional difference of alpha1-adrenoceptors in normal rats. In both male and female rats, diabetes decreased the contractile response in mesenteric arteries, which might be caused by the overall change in alpha1-adrenoceptor.

Review of anesthesia for robotic-assisted radical prostatectomy: in comparison with radical retropubic prostatectomy

BACKGROUND: Robotic-assisted radical prostatectomy (RARP) using da Vinci(R) Surgical System is an emerging technique for management of prostate cancer. With retrospective chart review of patients who had RARP or radical retropubic prostatectomy (RRP), we tried to evaluate and compare the effects on the factors related to patients' outcomes. METHODS: We reviewed the data of 144 patients who underwent RARP (group R, n = 76) or RRP (group C, n = 68) under general anesthesia in the same time period retrospectively.The age, anesthesia time, transfusion rate, PACU time, administration of additional analgesics at PACU, admission day after the operation, postoperative complications and intraoperative PaCO2 were examined and compared. RESULTS: Group R showed significantly lower transfusion rate and more rapid discharge after the operation. Intraoperative PaCO2 was increased in process of time in group R. Other variables were not significantly different between the two groups.In group R, mild neuropathy occurred in 2 patients and subcutaneous emphysema occurred in 1 patient. CONCLUSION: Patients who had RARP needed significantly less transfusion during operation and significantly shorter admission time compared to patients who had RRP.

Anesthetic management with neuromuscular monitoring and bispectral index in an amyotrophic lateral sclerosis patient: A case report / 대한마취과학회지

Amyotrophic lateral sclerosis is a neurodegenerative disease caused by the degeneration of upper and lower motor neurons. The disorder causes muscle weakness and atrophy throughout the body. There is an unexpected response to depolarizing or nondepolarizing muscle relaxants, and risk of perioperative respiratory failure is high. Careful monitoring and minimal doses of anesthetics are needed. We report a case of general anesthesia in a patient with amyotrophic lateral sclerosis. We used proper doses of muscle relaxant and inhalation anesthetics with neuromuscular monitoring and bispectral index. The patient early recovered from anesthesia without any respiratory complications.

Vital Capacity Induction with Sevoflurane in Children Results in Less Incidence of Withdrawal after Rocuronium than Tidal Volume Induction / 대한마취과학회지

BACKGROUND: The Vital capacity technique is known to have some advantages over the tidal volume technique during inhalation induction of anesthesia.The aim of this study was to compare the incidence of withdrawal movement associated with the intravenous administration of rocuronium 0.3 mg/kg in children during inhalation induction with sevoflurane using the tidal volume and vital capacity techniques. METHODS: We randomly assigned 130 patients (aged 5-12 years) to either tidal volume (group T) or vital capacity (group V) groups for inhalation induction with sevoflurane.Rocuronium 0.3 mg/kg was administrated after loss of the eyelash reflex.The time to loss of the eyelash reflex was recorded and adverse events during induction were documented.The patient's response to rocuronium injection was graded using a four-point scale. RESULTS: No significant differences were observed between the groups with respect to age, weight, and gender.The time to loss of the eyelash reflex was more rapid in group V than in group T (P < 0.05).Excitatory movement developed more frequently in group T, and no significant differences were found in the incidence of other adverse events between the groups.The incidence of withdrawal movement associated with the injection of rocuronium was significantly lower in group V compared to group T (30 vs. 60%; P < 0.05). CONCLUSIONS: Inhalation induction with sevoflurane using the vital capacity technique decreased the incidence of withdrawal movement during the injection of rocuronium compared to the tidal volume technique.

Comparison of Intrathecal Bupivacaine- Alfentanil and Bupivacaine-Fentanyl in Spinal Anesthesia for Cesarean Section

BACKGROUND: Additive opioids in spinal anesthesia of cesarean section decrease the dose of local anesthetics and increase the quality of anesthesia. There were comparative studies about morphine, fentanyl, and sufentanil as an additive opioid in spinal anesthesia of cesarean section, but few studies about alfentanil. In this study we compared the effect of alfentanil with fentanyl as an additive opioid in spinal anesthesia for cesarean section. METHODS: Sixty nine pregnant women, American Society of Anesthesiologist (ASA) I-II, who were scheduled for elective cesarean section under spinal anesthesia, were randomly allocated into two groups: group F received 8 mg (1.6 ml) of bupivacaine and 15microg of fentanyl (0.3 ml) intrathecally, and group A received 8 mg of bupivacaine and 150microg of alfentanil (0.3 ml). Sensory block defined by pin-prick, intraoperative patient satisfaction for analgesia by visual analogue scale (VAS), blood pressure, and side effects were assessed. Apgar score and umbilical arterial blood gas analysis were also assessed. RESULTS: The analgesic effect of alfentanil was as good as fentanyl and VAS for satisfaction was 97.1 +/- 7.6 and 96.5 +/- 8.0 each. Time to achieve anesthetic level of T6 (6.2 vs 6.7 min), maximal block level (T3.7 vs T3.8), lowest blood pressure during the operation (60.0 vs 61.0 mmHg), duration of analgesia (77.2 vs 70.0 min), and fetal assessment were not different from those of group F, either. The incidence of nausea during operation was 48.6% in group F and 26.4% in group A (P = 0.14). CONCLUSIONS: The addition of alfentanil is comparable to fentanyl in analgesia, maternal and fetal effects in spinal anesthesia for cesarean section.

Transient Submandibular Gland Swelling Developed after General Anesthesia: A case report / 대한마취과학회지

Acute transient salivary gland swelling is a rare complication of general anesthesia. These swellings usually resolve over a few hours without sequelae. The etiology of the salivary gland swelling is unclear. However, they are considered to be associated with cough or straining on the endotracheal tube and mechanical blockage of salivary gland duct. Anesthesiologists should know the possible causes, lack of clinical significance, and the course of these transient salivary gland swellings in order to reassure the patient. We report bilateral submandibular gland swelling developed after endotracheal anesthesia in a 4-year-old girl.

The Correlation between Bispectral Index andHemodynamic Responses with Skin Incision duringSevoflurane Anesthesia in Children / 대한마취과학회지

BACKGROUND: It is well documented that BIS reflects the level of sedation but conflicting results exist about whether BIS can reflect the depth of anesthesia. We intended to identify this issue by investigating the correlation between the pre-incision bispectral index (BIS) values and the hemodynamic responses to skin incision during sevoflurane-N2O anesthesia in children. METHODS: In total, 117 ASA physical status I or II pediatric patients, aged 6 mo-12 yr, were enrolled. After induction and intubation with thiopental, rocuronium, sevoflurane and N2O, patients were randomly allocated to one of the four end-tidal sevoflurane concentrations (ETsevo); 2.0, 2.5, 3.0, and 3.5 %; with 60% N2O. The ETsevo was maintained constant for more than 15 min before and 5 min after skin incision. BIS, heart rate (HR), and systolic arterial pressure (SAP) before and after skin incision were recorded. RESULTS: Although there were no correlation between pre-incision BIS and change in BIS, SAP, and HR (Pearson's coefficient -0.120, -0.102, and -0.080, respectively), there were correlations between changes of BIS and changes in SAP and HR (Pearson's coefficient 0.318 and 0.309, respectively, P < 0.05). CONCLUSIONS: There was a correlation between the change of BIS, but not BISpre, and change in hemodynamic variables with skin incision during sevoflurane anesthesia in children.

Anesthetic Management using Laryngeal Mask Airway during Tracheotomy and End-to-End Anastomosis in a Patient with Upper Tracheal Stenosis: A case report / 대한마취과학회지

Tracheotomy and end-to-end anastomosis is a relatively rare operation, but it is one of the most challenging for anesthesiologists. During surgery, the principal anesthetic consideration is to maintain the ventilation and oxygenation throughout the procedure. We experienced anesthetic management of a 49-year-old man with upper tracheal stenosis after long-term intubation and ventilation care. The stenotic lesion was located at 2 cm below the vocal cords, and the length of the stenotic segment was about 2 cm. The anesthesia was induced and maintained with intravenous propofol and alfentanil. The airway was managed with LMA and distal tracheal intubation on the surgical field and we were able to maintain adequate ventilation and oxygenation throughout the operational period.

Comparison of the Effects of Postoperative Continuous Plus Bolus Patient-Controlled Analgesia and of Bolus Patient-Controlled Analgesia in Children / 대한마취과학회지

BACKGROUND: Patient-controlled analgesia has been used with increasing frequency to provide postoperative pain relief for children. We compared the effects of continuous plus bolus patient-controlled fentanyl analgesia with those of bolus patient-controlled fentanyl analgesia. METHODS: One hundred and thirty four children (aged 3-8 yr) undergoing orthopedic surgeries received one of two analgesic regimens of fentanyl based patient-controlled analgesia (PCA); bolus infusion of 0.4microgram/kg with a 15 minute lock-out interval (group B) or continuous (0.2microgram/kg/hr) and bolus infusion (0.2microgram/kg) with a 15 minute lock-out interval (group C). We compared the two groups in terms of degree of analgesia, sedation and nausea. RESULTS: Analgesic effects were better in group B at 1 and 2 hours after surgery. The incidence of sedation in group C was greater than in group B at 1 and 2 hours after surgery, and the groups were similar in terms of the incidences of nausea. CONCLUSIONS: We concluded that bolus infusion of fentanyl in children did not increase the incidence of side effects and that it was associated with a better analgesic effect than continuous and bolus fentanyl infusion.

Response of Preoperative Anesthetic Explanation to Parents or Guardians for Elective Surgery Planned Children / 대한마취과학회지

BACKGROUND: Pre-anesthesia information of pediatric patients is usually conducted to their parents and sometimes inadequate information makes the parents very anxious about anesthesia. We designed this study to evaluate the response of pediatric patients' parents to pre-anesthesia information. METHODS: The data was collected based on the answers of 432 parents of pediatric patients to receive general anesthesia for elective surgery. The age of patient is under 17. At the day of admission they were received an explanatory pamphlet. Before the day of surgery, an anesthesiologist visited them and explained about conduct of general anesthesia and its possible complication. After the surgery, we asked the to answer the questionnaire. RESULTS: Eighty-five percent of the parents had informed about anesthesia and fifity-three percent of them were satisfied about the explanation. Eighty percent of the parents answered their anxiety about general anesthesia wasn't increased after the information and fifty percent of parents answered that it is necessary to tell the plain explanation about general anesthesia to pediatric patients. CONCLUSIONS: We concluded that pre-anesthetic information is useful to reduce the anxiety of pediatric patients' parents also we got information about what the parents wanted to know about the anesthesia and changes after anesthesia.

The Efficacy and Incidence of Side Effects in Patient Controlled Analgesia Using Hydromorphone / 대한마취과학회지

BACKGROUND: Hydromorphone, a derivative of morphine, has the same actions and uses as morphine, has about eight times more potency on a milligram basis. Hydromorphone is used for the relief of moderate to severe pain. There has been no report in Korea on patient controlled analgesia (PCA) using hydromorphone. Here, the efficacy and incidence of side effects of PCA, with hydromorphone, were investigated. METHODS: 68 patients scheduled for spinal, urological, gynecological and general surgery were enrolled. Patients received standardized general anesthesia, with the PCA initiated at the end of surgery. Parameters for PCA were a 0.1 mg bolus and 0.05 mg/hr infusion of hydromorphone, with a 10 min lockout interval. A verbal rating scale (1: none, 2: very mild, 3: mild, 4: moderate, 5: severe) of pain, nausea (mild, moderate, severe), vomiting, dizziness and somnolence were assessed at 6, 12, 24 hr postoperatively. The amount of hydromorphone used and the requirements for symptomatic relief were also recorded. RESULTS: The mean pain scores were 3.5+/-0.8, 2.9+/-0.8 and 2.5+/-0.7, and the amounts of hydromorphone delivered were 1.0+/-0.1, 1.8+/-1.0 and 2.7+/-1.3 mg, 6, 12 and 24 hr postoperatively, respectively. The incidence of nausea, vomiting, dizziness and somnolence were 17.6, 4.4, 8.8 and 1.5%, respectively. CONCLUSIONS: Intravenous PCA, with hydromorphone, was effective in controlling postoperative pain, with fewer eide effects than morphine, as reported in the literature.

Cardiac Arrest under Anesthesia in a Child with Previously Undiagnosed Long QT Syndrome: A case report / 대한마취과학회지

Congenital long QT syndrome is a rare but potentially lethal disease, characterized by a corrected QT interval of at least 440 msec, ventricular arrhythmia, recurrent syncope, and sudden death. We experienced a case of sudden cardiac arrest during general anesthesia in a child who was later documented to have congenital long QT syndrome. We report this experience with a brief review of literature.

General Anesthesia with Sevoflurane for a Patient with MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, Stroke-like Episodes) Syndrome: A case report / 대한마취과학회지

We describe the anesthetic management of a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, stroke-like episodes (MELAS) syndrome, and a form of mitochondrial myopathy. A 14 year-old-male with MELAS syndrome underwent tracheostomy under general anesthesia. Anesthesia was managed with thiopental sodium, nitrous oxide, sevoflurane, and rocuronium. His reactions to anesthetics and muscle relaxant were within normal limits. No serious complication was observed. The implication of MELAS syndrome for anesthesia are discussed.

The Differences in Bispectral Index according to Age during Sevoflurane Anesthesia in Children Aged 1-7 Years / 대한마취과학회지

BACKGROUND: The bispectral index (BIS) was developed for adults, and the influence of neuronal and physiologic brain maturation on BIS in pediatric patients is unknown. The aim of this study was to evaluate BIS during anesthesia, using the same sevoflurane with respect to age in young children. METHODS: Forty-two pediatric patients, aged 1-7 years, were enrolled in this study. Without premedication, anesthesia was induced with atropine, thiopental, and rocuronium and maintained with 2.0-2.5% sevoflurane and 50% N2O-50% O2. After induction, a pediatric BIS sensor was applied and monitored throughout the maintenance of and emergence from anesthesia. RESULTS: BIS was analyzed in different age groups; 1-2 yr (n = 14), 3-4 yr (n = 13), 5-7 yr (n = 15). Operation and anesthesia times were similar forthe three age groups. Mean BIS values from ten minutes after skin incision to just before sevoflurane cessation (BISmean) were 67.0 +/- 6.2 for 1-2 yr, 50.5 +/- 9.4 for 3-4 yr, and 39.8 +/- 6.9 for 5-7 yr, and these values were significantly different for the three age groups. No significant differences were observed for extubation times, or times to a BIS value of 70 or 90 during anesthesia recovery. CONCLUSIONS: When monitoring BIS in children aged 1-7 yr during anesthesia with sevoflurane, the BIS trend rather than the absolute value is more important and the BIS data, especially in children under 3 years of age, should be interpreted cautiously.

The Effect of Isoproterenol, Dobutamine, and Milrinone on Pulmonary Vasoconstriction in Isolated Rat Lungs / 대한마취과학회지

BACKGROUND: Dobutamine, isoproterenol, and milrinone are inotropic agents with vasodilatory properties, and are frequently used perioperatively. We undertook to examine the effects of these three drugs on the pulmonary vasculature, excluding cardiovascular effects, by determining their effects on pulmonary artery pressure and hypoxic pulmonary vasoconstriction in an isolated rat lung model. METHODS: Thirty Sprague-Dawley rats were divided into a dobutamine group (n = 10), an isoproterenol group (n = 10) and a milrinone group (n = 10). Dobutamine 50microgram, 500microgram, and 5,000microgram, isoproterenol 0.4microgram, 4microgram, and 40microgram, and milrinone 2.5microgram, 25microgram, and 250microgram were added to perfusate sequentially during normoxic ventilation (21% O2-5% CO2-balanced N2). Baseline pulmonary artery pressure changes and subsequent hypoxic pressor responses during hypoxic ventilation (5% O2-5% CO2-balanced N2) were observed. RESULTS: Dobutamine, isoproterenol, and milrinone all decreased baseline pulmonary artery pressures and hypoxic pressor responses in a dose-dependent manner (P < 0.05). The last dose listed for each of the three drugs reversed hypoxic pulmonary vasoconstriction nearly completely. The calculated dose required to reduce the hypoxic pressor response to 50% of the initial response before drug administration (ED50) was 155microgram (95% CI: 80-263microgram) for dobutamine, 0.23microgram (95% CI: 0.011-0.75 microgram) for isoproterenol and 6.31microgram (95% CI: 3.1-10.8microgram) for milrinone. The relative potency of the drugs on HPV, based on ED50 was dobutamine 10: isoproterenol 0.015: and milrinone 0.41. CONCLUSIONS: Dobutamine, isoproterenol, and milrinone all reduced pulmonary vascular resistance and hypoxic pulmonary vasoconstriction in a dose dependent manner. (Korean J Anesthesiol 2004; 46: 454~461)

Anaesthetic Management of an Adult with a Modified Fontan Procedure in Noncardiac Surgery: A case report / 대한마취과학회지

Given improvements in the diagnosis and treatment of congenital heart disease, more patients with heart disease reach adolescence or adulthood and require noncardiac surgery. Since 1971, the Fontan operation has been widely used for the management of tricuspid atresia and a variety of univentricular heart malformations. Although the life expectancy of these patients has increased, few reports are available on their anaesthetic management when a noncardiac operation is indicated. We report on the anaesthetic management of a 40-years-old male patient scheduled for permanent pacemaker insertion who underwent a modified Fontan procedure at the age of 27 years for pulmonary stenosis, common atrioventricular cushion defect, and for corrected transposition of the great arteries