Short-term outcomes after surgical versus trans catheter closure of atrial septal defects; a study from Iran.

OBJECTIVES: Atrial Septal Defect (ASD) accounts for 10% of congenital cardiac defects. The purpose of this retrospective study was to compare the short-term outcomes of surgical versus trans catheter closure of secundum atrial septal defect. METHODS: This is a single-center retrospective cohort study in patients who had surgical or trans catheter ASD closure. ASD closure outcomes such as hospital cost, length of hospital and ICU stay, residual ASDs, complications, readmission, hospital and three month mortality were recorded and compared. RESULTS: Between March 2010 and March 2016, total of 102 secundum ASD patients were treated in our center (71 patients surgical ASD closure and 31 patients trans catheter ASD closure). About 13.9% of patients (5/36) in the device group had failed procedural attempt for various reasons and these patients underwent surgery closure. Complete closure was observed in 26 of 31 patients (83.9%) in the device group and in 70 of 71 patients in the surgery group (98.6%). The mean length of hospital stay was 5.56 days for surgical group and 2.06 days for device group. The procedure cost for surgery was found to be 5.7% lower than trans catheter closure (patient payment). The complication rates were 18.3% for surgical group and 25.8% for the device group. Readmission after discharge was more common in surgery group (11.2 vs 6.4%). Hospital and three months mortality in both groups were zero. CONCLUSIONS: Both trans catheter and surgical procedure are good methods of successful ASD closure. Considering that the surgical group patients were higher risk patients, mean total hospital cost of patient's procedures were significantly higher in device closure group, failed intervention rate and residual ASD were more common in device group and complications of device group were more serious; thus, appropriate patient selection is an important factor for successful device closure.

Anesthetic Management of an Infant Presenting with an Intrapericardial Tumor: A Case Report.

Intrapericardial teratomas are rare primary cardiac tumors. These tumors, albeit benign in essence, can be fatal if they exert pressure on the cardiovascular and/or respiratory system. We describe a 34-day-old infant, who needed emergent surgery due to cardiovascular structure compromise. Proper anesthetic and surgical techniques conferred an uneventful postoperative course. Histologic examination confirmed the tumor as an intrapericardial teratoma. At 8 months' postoperative follow-up, the child had a good developmental status and a normal echocardiogram.

Comparison of the effects of pretreatment intravenous fentanyl or intravenous lidocaine on suppression of fentanyl-induced cough in children: a randomized, double-blind, controlled clinical trial.

BACKGROUND AND AIM: The injection of fentanyl usually causes coughing during induction of anesthesia. Based on a few studies about effects of lidocaine and the fact there is no study concerning the effect of fentanyl on fentanyl-induced cough in pediatric patients, the aim of this study was to compare the effectiveness of low dose of fentanyl with lidocaine in prevention of fentanyl-induced cough in children. METHODS: This randomized double-blind controlled clinical trial study was conducted at Motahari Hospital between February and August 2017 in Urmia (Iran). One hundred patients, aged 2-10 years, of class I or II ASA status who were candidates for elective herniorrhaphy under general anesthesia were enrolled in this study. They were randomly divided into three groups. One minute before the administration of 2 µg/kg fentanyl during induction of general anesthesia, Group I received 1.0 mg/kg lidocaine (n=33), Group II received 0.5 µg/kg fentanyl (n=34) and Group III received normal saline as a control group (n=33). The data were analyzed by STAT version 13. The incidence and severity of cough were determined across groups by using ANOVA and Chi-square tests. Multiple logistic regression was also used to examine the association between the outcome of cough incidence and clinical interventions as the exposures after adjusting for study covariates. RESULTS: The highest incidence of cough was found in the Group III (54.5%) versus 32.4% and 21.1% in Group II and Group I subsequently (p=0.02). We have also found significant difference in the incidence of cough among group one and three (p=0.005), and among group two and three (p=0.045). No statistically significant difference has been detected between group one and two. The severity of cough was significantly higher in Group III compared to Groups I and II (p=0.01). The time of onset of cough was similar across groups. No side effects were reported after intervention in this study. CONCLUSION: This study found that pretreatment with fentanyl 0.5mg/kg or 1mg/kg lidocaine is an effective approach to reducing the incidence and severity of fentanyl-induced cough in children. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials (http://WWW.irct.ir) with IRCT number: IRCT2016112027677N5. FUNDING: This study was not granted or funded by any institution.

Comparing prophylactic effect of phenylephrine and ephedrine on hypotension during spinal anesthesia for hip fracture surgery.

BACKGROUND: Spinal anesthesia is an accepted technique in hip fracture surgery and prevention of this complication by sympathomimetic agents is of potential clinical significance. The aim of this study is to compare the effect of prophylactic phenylephrine versus ephedrine in the prevention of hypotension during spinal anesthesia in hip fracture surgery. MATERIALS AND METHODS: Ninety-two patients undergoing hip fracture surgery with the American Society of Anesthesiologists I and II were randomized to receive prophylaxis with ephedrine or phenylephrine immediately before the spinal anesthesia. Patients in the ephedrine group received an intravenous (IV) bolus of 10 mg ephedrine, and patients in the phenylephrine group received an IV bolus of 50 µg phenylephrine. We recorded mean arterial pressure (MAP), systolic and diastolic blood pressure, heart rate every 3 min in the first 10 min and then every 5 min until 30 min after spinal anesthesia, nausea and vomiting, additional vasopressor, and atropine administration. RESULTS: The frequency of hypotension was significantly lower in MAP, systolic and diastolic pressure in group phenylephrine in 3, 6, and 9 min after spinal anesthesia (P = 0.002, P = 0.001). There were no significant differences between two groups in heart rate at different time of study. In the phenylephrine group, lower additional vasopressor was used (8.7% and 23.9%) (P = 0.04). There were no significant differences between two groups in the use of atropine (P = 0.24), nausea and vomiting. CONCLUSION: At the doses of ephedrine and phenylephrine administered in this trial, phenylephrine was better to prevent hypotension during hip fracture surgery with spinal anesthesia. Higher frequency of hypotension was observed in the ephedrine group.