Document Detail

The effect of cardioplegic solution-induced sodium concentration fluctuation on postoperative seizure in pediatric cardiac patients.
MedLine Citation:
PMID:  21511247     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Despite potential benefits of histidine-tryptophan-ketoglutarate (HTK) solution as a cardioplegic solution, it can cause hyponatremia, especially in pediatric patients. Fluctuations in the sodium concentration during cardiopulmonary bypass (CPB) can adversely affect the central nervous system. We evaluated the relationship between the cardioplegic solution, the fluctuation of sodium concentration, and the incidence of postoperative seizure in pediatric cardiac patients.
METHODS: The medical records of 628 patients were reviewed for the occurrence of a postoperative seizure, type of cardioplegic solution (HTK or del Nido solution), and intraoperative data. A change of sodium concentration exceeding 15 mmol/L (ΔNa>15) during CPB was defined as a significant fluctuation of sodium concentration.
RESULTS: Postoperative seizures were detected in 18 patients (2.9%). The ΔNa>15 was detected in 63 of 189 patients (33.3%) who received the HTK solution and in 14 of 439 patients (3.2%) who received the del Nido solution (p<0.001). The incidence of ΔNa>15 was strongly associated with postoperative seizure (odds ratio, 6.3; 95% confidence interval, 2.4 to 16.4, p=0.001). After adjusting for potential confounders, the ΔNa>15 remained significantly associated with postoperative seizure (odds ratio, 3.9; 95% confidence interval, 1.3 to 12.3, p=0.018).
CONCLUSIONS: Histidine-tryptophan-ketoglutarate solution during CPB frequently causes fluctuations of sodium concentration, usually combined with hyponatremia, which is associated with postoperative seizure. Special attention to sodium concentration is required, particularly when HTK solution is used in pediatric cardiac patients.
Jin-Tae Kim; Young-Hee Park; Young-Eun Chang; Hyo-Jin Byon; Hee-Soo Kim; Chong-Sung Kim; Hong-Gook Lim; Woong-Han Kim; Jeong-Ryul Lee; Yong-Jin Kim
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Publication Detail:
Type:  Journal Article     Date:  2011-04-20
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  91     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-30     Completed Date:  2011-08-11     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1943-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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MeSH Terms
Cardiac Surgical Procedures / adverse effects*
Cardioplegic Solutions / adverse effects*
Cardiopulmonary Bypass
Child, Preschool
Glucose / adverse effects
Mannitol / adverse effects
Postoperative Complications / etiology*
Potassium Chloride / adverse effects
Procaine / adverse effects
Seizures / etiology*
Sodium / blood*
Reg. No./Substance:
0/Bretschneider cardioplegic solution; 0/Cardioplegic Solutions; 50-99-7/Glucose; 59-46-1/Procaine; 69-65-8/Mannitol; 7440-23-5/Sodium; 7447-40-7/Potassium Chloride
Comment In:
Ann Thorac Surg. 2012 Feb;93(2):692-3; author reply 693   [PMID:  22269751 ]
Ann Thorac Surg. 2012 Jun;93(6):2120-1; author reply 2121   [PMID:  22632526 ]
Ann Thorac Surg. 2013 May;95(5):1844-5   [PMID:  23608285 ]
Ann Thorac Surg. 2013 May;95(5):1845   [PMID:  23608287 ]

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