Comparison of hemodynamic response and postoperative pain score between general anaesthesia with intravenous analgesia versus general anesthesia with caudal analgesia in pediatric patients undergoing open-heart surgery

Context: Regional anesthesia may attenuate adverse physiological stress responses associated with cardiothoracic surgery. In this study, hemodynamic stress response at the different time of surgical stimuli was compared between patients receiving general anesthesia (GA) along with caudal epidural analgesia with GA with intravenous analgesia in pediatric population undergoing open-heart surgery. Aims: This study aims to compare the hemodynamic response at the different time of surgical stimuli and postoperative pain score, in pediatric patients undergoing open-heart procedures. Settings and Design: We designed a prospective randomized controlled trial to study hemodynamic effects between Group I and Group II. Fifty patients were randomly allocated equally into Group I (GA + caudal epidural) and Group II (GA + intravenous analgesia) by sealed envelope technique. Subjects and Methods: After obtaining approval from Institutional Ethical Committee, this prospective study was conducted in 50 American Society of Anesthesiologist Classes II and III pediatric patients aged between 1 and 12 years posted for cardiac surgery in our institution. Statistical Analysis: ANOVA, two-way ANOVA, and Student's test. Results: The heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure variations were compared between Groups I and II at different time intervals. The variations were found to be significantly higher at the time of skin incision and 2 min after skin incision in Group II as compared to Group I. Pain score was compared between the groups and was found to be significantly lower with Group I (2.5 ± 1.2) as compared to Group II (4.6 ± 1.7), P = (0.004). Conclusions: Caudal analgesia with GA (Group I) was found to have better hemodynamic control and significantly better postoperative pain relief in the first 24 h after awakening.

Predisposing Factors of Postoperative Pulmonary Complication in Children with Congenital Heart Disease

PURPOSE: Postoperative care usually required 24-48 hours at intensive care unit (ICU) in children with congenital heart disease. More longer ICU stay may give more chances to produce the postoperative complications. Postoperative pulmonary complication is produced to a much higher incidence after longer immobilized state with keeping catheters and arterial and venous lines. So, we evaluated the predisposing factors those are oriented to ICU stay factors and age, hematologic abnormalities, hepatic dysfunction, infections during ICU care in children with congenital heart disease. METHODS: A retrospective review was performed of postoperative factors for children undergoing open heart surgery in intensive cardiac unit, Wonkwang medical cardiac center. A total of 193 pediatric patients who had cardiac surgery with cardiopulmonary bypass in a 10 year period from Jan. 1995 until Dec. 2004 were reviewed. After logistic regression test, predisposing factors were deemed significant if associated with a pulmonary complication with P<0.05. RESULTS: Children who fell postoperative pulmonary complication in our institution occupied 15% of 193 patients with congenital heart disease. Of all clinical factors considered, those significantly associated with postoperative pulmonary complication were as follows: high ALT level, longer duration of mechanical ventilation and arterial line maintenance. CONCLUSION: Prompt weaning of mechanical ventilation and removal of arterial line during ICU stay in children underwent open heart surgery may be necessary to decrease the risks of postoperative pulmonary complication.

The Analgesic Effects of Caudal Morphine and Meperidine Containing Bupivacaine in Pediatric Open Heart Surgery / 대한마취과학회지

BACKGROUND: In both infants and children, increased hormonal and metabolic responses to open heart surgery may be directly related to postoperative complications. Anesthestic management including regional anesthesia can substantially attenuate a perioperative stress response and targeted therapy may improve the outcome. In this study, our objectives were to quantify the extent of pain control, and to evaluate the safety and efficacy of caudal morphine or meperidine. METHODS: Seventy-five pediatric patients undergoing a open heart surgery were randomly assigned to three groups according to receiving morphine (group M, n = 25), or meperidine (group D, n = 25) caudally, and a control group (group C). Caudal morphine 30ng/kg with 0.15% bupivacaine 1 ml/kg or meperidine 2 mg/kg with 0.15% bupivacaine 1 ml/kg was injected after anesthetic induction. Pain score and side effects were evaluated immediate postoperatively, 12, 24, and 48 hr postoperatively in the intensive care unit and consciousness recovery and extubation time were checked. RESULTS: Patients in the groups M and D had significantly lower pain scores than the group C. Recovery and extubation time were shorter in the groups M and D. Incidence of nausea and vomiting was significantly higher in the group M than in the groups D and C. CONCLUSIONS: Caudal morphine and meperidine reduced postoperative pain and facilitated extubation.

The Change of Colloid Osmotic Pressure during Pediatric Open Heart Surgery / 대한마취과학회지

To evaluate the change of colloid osmotic pressure(COP) and the correlation between COP and other parameters during pediatric open heart surgery at Seoul National University Children's Hospital, COP, protein, albumin, hemoglobin, and hematocrit, were measured immediately after induction(T1), before cardiopulmonary bypass(CPB)(T3), duringT4, T5), and after bypass(T.6, T7) and immediately after(T8) and 24 hour after(T9) arrival at intensive care unit (ICU) in l0 pediatric patients aged from l year to 13 years. Above parameters of priming solution(T2) were also measured. The results were as followings; l) The good correlation between COP and protein(r=0.87), albumin(r=0.86), hemoglobin(r=0. 80), hematocrit(r=0.77) were showed. 2) The COP of priming solution was 9.42.6 mmHg and this was definitely lower than normal value. 3) The COP during CPB was in the range from 11 to 12 mmHg(mean values) and this value was also significantly lower than normal value. 4) The COP increased from the time of weaning from CPB, but the COP at the arrival at ICU was 18.0+/-1.2 mmHg and this value was still significantly lower than normal value. 5) The COP at 24 hours after arrival at ICU was 21.7+/-1.2 mmHg and this value was not significantly different fron normal value. Thus, the results suggest that the priming solution shuold be improved to maintain COP during and immediatelt after CPB.

The Comparison of Postoperative Recovery Time and Ventilatory Support Time in the Pediatric Open - heart Patients Anesthetized With Morphine or Fentanyl / 대한마취과학회지

In a randomized study of 16 pediatric patients undergone open-heart surgery, the postoperative recovery time and ventilatory support time of the patients anesthetized with fentany (fentanyl group, n=8) was compared with those of the patients anesthetized with morphine (morphine group, n=8). All patients were premedicated with 0.1 mg/kg of morphine and 0.008mg/kg of glycoppyrolate i.m. 1hr prior to anesthesia. In morphine group, anesthesia was induced with morphine 0.5mg/kg and thiopental 3 mg/kg and in fentanyl group with fentanyl 5 ug/kg and thiopental 3 mg/kg. Anesthesia was maintained with assigned opiate based upon cardiovascular signs. The total doses of opiates are 3.2mg/kg in morphine group and 34.3pg/kg in fentanyl group. In fentanyl group the time to regain consciousness (107+/-53min), ventilatory support time (209+/-53min) and the time from end of operation to extubation (589+/-82min) are significantly shorter than in morphine group (142+/-41min, 838+/-220min, 1470+/-269min, respectively). From the above results fentanyl is more suitable i.v. anesthetic agent for open-heart surgry in respect of postoperative ventilatory care.