Document Detail


Anesthesia for arterial switch operation in simple transposition of the great arteries: experience at Siriraj Hospital.
MedLine Citation:
PMID:  12452217     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Anesthetic management of cardiac patients with complete transposition of the great arteries (TGA) undergoing arterial switch operation (ASO) is challenging. The anesthetic course and perioperative problems were studied. A prospective data collection study of 87 patients was performed between January 1991 and February 2002. The patients were divided into 3 groups: Group 1; 27 neonates with TGA with an intact ventricular septum (IVS), Group 2; 21 with TGA, with IVS who underwent two-stage ASO, and Group 3; 39 with TGA, with a large VSD. The anesthesia consisted of low-dose fentanyl, thiopental, atracurium and isoflurane. Monitoring included ECG, radial or femoral arterial pressure, CVP, LAP, core temperature, SpO2, P(E)CO2, urine output, ABG's, Hct, ACT, serum glucose and potassium. Fortunately the courses of anesthesia were uneventful. Usual vasoactive medication administered following CPB included nitroglycerin, dobutamine and dopamine. Groups I, 2 and 3 contained 18.5 per cent, 14.3 per cent and 33.3 per cent of patients who required adrenaline respectively. And only 7.7 per cent of patients in Group 3 had milrinone as an inotrope. Early tracheal extubation, 2 hours after admission to ICU was performed in 3 patients. Perioperative complications included bleeding, low cardiac output, diaphragmatic paresis, digitalis intoxication, metabolic alkalosis, convulsion, pulmonary hypertensive crisis and death. Two patients who developed a pulmonary hypertensive crisis were successfully managed with inhaled nitric oxide. The overall hospital mortality rate was 19.54 per cent. In conclusion, the anesthetic management for ASO in 87 simple dTGA patients was uneventful at Siriraj Hospital. The major perioperative morbidity and hospital mortality were not directly anesthetic contribution.
Authors:
Ungkab Prakanrattana; Sirilak Suksompong; Somchai Sriyoschati; Samphant Pornvilawan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the Medical Association of Thailand = Chotmaihet thangphaet     Volume:  85 Suppl 3     ISSN:  0125-2208     ISO Abbreviation:  J Med Assoc Thai     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-11-27     Completed Date:  2003-01-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7507216     Medline TA:  J Med Assoc Thai     Country:  Thailand    
Other Details:
Languages:  eng     Pagination:  S815-23     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Anesthesia / methods*
Chi-Square Distribution
Female
Heart Septal Defects, Ventricular / mortality,  surgery
Hospital Mortality
Humans
Infant
Infant, Newborn
Male
Postoperative Complications
Prospective Studies
Transposition of Great Vessels / mortality,  surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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