[Use of aprotinin during pediatric heart surgery]. / Utilización de aprotinina en cirugía cardíaca pediátrica.

OBJECTIVE: To study the efficacy of high doses of aprotinin during cardiopulmonary bypass (CPBP) in pediatric patients with a tendency to intra- and postoperative bleeding: children undergoing repeated operations and those with cyanotic cardiopathy. PATIENTS AND METHODS: A simple retrospective, random sample of 71 pediatric patients with cyanogenic cardiopathy was studied. Group I (n = 36) received a test dose of 50,000 KIU in 2 min. The initial dose was 1,700,000 KIU (170 ml/m2 of body surface) i.v., at an infusion rate of 150 ml/h. CPBP circuit prime dose was 1,700,000 (170 ml/m2 of body surface), with replacement at a volume equivalent to the circuit prime. The maintenance dose was 400,000 KIU (40 ml/m2/h) i.v. Infusion was suspended 2 hours after a patient's arrival at the intensive care unit (ICU). We recorded red blood cell loss and blood product requirements in the first 24 hours in the ICU, duration of surgery, intra- and postoperative diuresis, and complications. RESULTS: Group I required 13.96 +/- 12.09 ml/kg/h of packed red cells whereas Group II required 22 +/- 16.22 ml/kg/h (p < 0.05). The volume lost was less in Group I than in Group II (0.77 +/- 0.48 ml/kg/h vs. 2.12 +/- 3.9 ml/kg/h; p < 0.05). The means for intra- and postoperative diuresis in the first 24 hours were not significantly different. CONCLUSIONS: Aprotinin significantly reduces red blood cell loss and homologous blood transfusion requirements. No complications attributable to aprotinin were observed.

Utilización de aprotinina en cirugía cardíaca pediátrica / Use of aprotinin during pediatric heart surgery

OBJETIVO. Estudiar la eficacia de altas dosis de aprotinina durante la circulación extracorpórea (CEC) en pacientes pediátricos con especial tendencia a la hemorragia intra y postoperatoria: niños reintervenidos y aquellos que presentan cardiopatía cianótica.PACIENTES Y MÉTODOS. Se escogió por muestreo simple aleatorio y de forma retrospectiva a 71 pacientes pediátricos con cardiopatía cianógena. El grupo I (n = 36) recibió una dosis test de 50.000 CIU (unidades inhibidoras de calicreína) en 2 min. La dosis inicial fue de 1.700.000 CIU (170 ml/m2 de superficie corporal) por vía intravenosa, a una velocidad de infusión de 150 ml/h. La dosis de cebado del circuito de CEC 1.700.000, 170 ml/m2 de superficie corporal, reemplazándose a un volumen equivalente del cebado del circuito. La dosis de mantenimiento fue de 400.000 CIU, 40 ml/m2/h por vía intravenosa. La perfusión fue suspendida a las 2 h de llegada a la UCI. Se valoraron las pérdidas hemáticas y las necesidades de hemoderivado en las primeras 24 h de estancia en la UCI, los tiempos quirúrgicos, la diuresis intra y postoperatoria, así como las complicaciones.RESULTADOS. El grupo I necesitó 13,96 ñ 12,09 ml/kg/h de concentrado de hematíes frente a los 22 ñ 16,22 ml/kg/h del grupo II (p < 0,05). El volumen drenado del grupo I fue menor que el del grupo II (0,77 ñ 0,48 ml/kg/h frente a 2,12 ñ 3,9 ml/kg/h; p < 0,05). No existieron diferencias significativas en la diuresis media tanto intraoperatoria como en el primer día postoperatorio.CONCLUSIONES. El uso de aprotinina reduce significativamente las pérdidas hemáticas y los requerimientos de sangre homóloga. No se objetivaron efectos clínicos adversos atribuibles a la aprotinina (AU)

No disponible

[Tracheal intubation using bronchofiberoscopy (experience of a hospital service)]. / Intubación traqueal mediante broncofibroscopia (experiencia de un servicio hospitalario).

Fiberoptic endoscopy has brought about significant progress in the management of so-called difficult intubations. We describe the techniques applied and results in one hospital service performing intubation guided by fiberoptic bronchoscope (FB). A total of 512 consecutive intubations (64.18% men and 35.15% women) performed over the past 18 years were analyzed. Non-tumor related disease of the cervical column (28.91%) was the most frequent cause of difficult intubation requiring FB guidance, followed by trauma (18.16%) and technical difficulties (17.39%). A nasal route was used most often (80.86%). In 93.16% of cases, intubation was needed for surgery. Thirty-five (6.84%) complications of various types were recorded, and intubation was impossible in 3 (0.59%) cases. Intubation in patients under general anesthesia presented special technical difficulties due to loss of muscle tone and the need to maintain ventilation. We recommend intubation only in patients who are breathing spontaneously through the nose, using lidocaine as a local anesthetic and a large caliber endotracheal tube with as small a tip as possible.

[Ingestion of hydrogen peroxide. Apropos of 3 cases]. / Ingestión de peróxido de hidrógeno. A propósito de tres casos.

Hydrogen peroxide is used as a preserver in milk industry. Three cases of accidental ingestion of 60% hydrogen peroxide (oxygenated water 200 volumes). The patients were male stockbreeders aged 30, 45 and 62 years, respectively, who stored that powerful oxidizing agent in commercial drink containers without adequate labeling. One of them was admitted comatose and required assisted ventilation. After recovering consciousness migratory paresis of right limbs and of the VI cranial nerve were observed, which were reversed after ten days, and left hemiparesia that persisted for two months. Upper gastrointestinal tract lesions, particularly in stomach, were detected in all. The endoscopic and pathological findings are described in detail. The outcome was satisfactory in the three patients, with complete remission of the lesions. There appears to be a direct relationship between the severity of symptoms and the amount of ingested peroxide, dependent on the diameter of the opening of the container. Only five reports have been identified related to the oral poisoning by this substance.