ABSTRACT
BACKGROUND: The purpose of this prospective, randomized, blinded to observer study was to assess the analgesic effect and safety of intrathecal morphine (ITM) in post-operative pain control in children after heart surgery with a sternotomy incision. METHODS: Eighty children, 3-55 kg in body weight, undergoing elective cardiac surgery with opioid-based anaesthesia were randomly divided into two treatment groups to receive either 20 micrograms/kg ITM at induction of anaesthesia or control. To standardize the protocol for administration of post-operative rescue intravenous morphine boluses and infusion (20-60 micrograms/kg/h), the Cardiac Analgesic Assessment Scale (CAAS) was used. RESULTS: Nine patients were excluded from the study after randomization. Thirty-five patients were enrolled to the ITM group and 36 to the control group. The groups were similar for demographics and intra-operative clinical characteristics. The mean time for the first intravenous morphine dose from ITM administration or equivalent time zero in the control group was significantly longer (P = 0.003) in the ITM group compared with the control group (12.3 vs. 8.7 h). Time from Paediatric Intensive Care Unit (PICU) admission to the start of intravenous morphine was also significantly longer (P = 0.01) in the ITM group (6.0 vs. 3.4 h). The total intravenous morphine consumption over the mean 19 post-operative hours was significantly lower (P = 0.03) in the ITM group. However, the use of ITM did not result in earlier extubation or earlier discharge from the PICU. Of the 35 patients who received ITM at induction of anesthesia, 20% (n = 7) did not require any additional morphine in the PICU compared with three out of 36 control group patients. This did not reach statistical significance. The incidence of adverse events was low in both groups. CONCLUSIONS: An ITM dose of 20 micrograms/kg had a significant (P = 0.03) intravenous morphine-sparing effect after cardiac surgery. Effective analgesia was observed for 12 h after administration of intrathecal morphine.
Subject(s)
Cardiac Surgical Procedures , Morphine/administration & dosage , Pain, Postoperative/drug therapy , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Morphine/adverse effects , Prospective StudiesABSTRACT
The incidence of cardiac tamponade after cardiac surgery is reported as ranging from 0.04% to 7%. Although a relatively infrequent complication, tamponade is associated with significant morbidity and mortality. Reports of tamponade after pediatric cardiac surgery are few and generally associated with postcardiotomy syndrome or, less commonly, removal of left atrial or pulmonary artery catheters after surgery. A case is presented of cardiac tamponade in a pediatric patient resulting from removal of a direct atrial and a pulmonary artery catheter after cardiac surgery. The pathophysiology of cardiac tamponade is reviewed and the increased risk for pediatric patients is outlined. The case review is conducted in the context of existing policies in the reporting institution and recommendations for practice are discussed.
Subject(s)
Cardiac Catheterization/adverse effects , Cardiac Tamponade/etiology , Cardiac Tamponade/epidemiology , Cardiac Tamponade/physiopathology , Down Syndrome/complications , Hemostasis/physiology , Humans , Infant, Newborn , Male , Monitoring, Physiologic/instrumentation , Postoperative Care , Risk FactorsABSTRACT
In traumatically injured or medically unstable pediatric patients requiring resuscitation, gaining intravenous access often is frustrating for the physician and agonizing for the patient. Even when cardiopulmonary resuscitation is performed by trained professionals, cardiac arrests in children in the prehospital setting have a mortality of 79% to 100%. Immediate vascular access such as that obtained by intraosseous infusion improves survival. The intraosseous infusion technique uses the medullary cavity in the tibia as a "noncollapsible vein" for parenteral infusion. It is indicated in a child in shock or cardiac arrest when two attempts to access peripheral vasculature have failed or when more than 2 minutes have elapsed in the attempt to gain access. Epinephrine, bicarbonate, calcium, lidocaine, and volume expanders can be infused via the intraosseous route. Complications rarely occur. The technique described here is gaining acceptance in both prehospital and emergency department settings.
Subject(s)
Cardiopulmonary Resuscitation/methods , Fluid Therapy/methods , Infusions, Intraosseous/methods , Cardiopulmonary Resuscitation/instrumentation , Child , Emergencies , Fluid Therapy/instrumentation , Humans , Infusions, Intraosseous/adverse effects , Infusions, Intraosseous/instrumentationABSTRACT
Noninvasive external cardiac pacing has been used safely in various cardiac emergencies for over 30 yr. Its use in neonates, however, has been associated recently with burns. We report the case of a 7-wk-old infant who sustained a full-thickness burn after prolonged use of an external pacing device.
