Anaesthesia with profound hypothermia in a case of transposition of the great vessels with renal failure
| Autor: | G. R. Avery, W. A. Dodds, K. W. Turnbull |
|---|---|
| Rok vydání: | 1974 |
| Předmět: |
Anesthesia
Endotracheal medicine.medical_specialty Cardiac output Cardiac Catheterization medicine.medical_treatment Transposition of Great Vessels Tubocurarine Infant Newborn Diseases Peritoneal dialysis Hypothermia Induced Internal medicine medicine Intubation Intratracheal Humans Balloon septostomy Postoperative Care Cardiopulmonary Bypass business.industry Infant Newborn Infant General Medicine Hypothermia Transposition of the great vessels Acute Kidney Injury medicine.disease Respiration Artificial Oxygen Anesthesiology and Pain Medicine Heart failure Anesthesia Heart catheterization Cardiology Anuria Female medicine.symptom business Halothane |
| Zdroj: | Canadian Anaesthetists' Society journal. 21(5) |
| ISSN: | 0008-2856 |
| Popis: | Tim trSE OF PI1OFOUND HYPOTHEHMIA for intra-cardiac surgery in infants and neonates has resulted in improved surgical conditions l and decreased paediatric mortality. Many of the candidates for profound hypothermia are in the high-risk categories. This report concerns a four-month-old girl weighing 5 kg who had preoperative renal failure requiring peritoneal dialysis. The cardiac output of this infant had progressively fallen. The increased demands of growth precipitated heart failure in a heart already compromised by transposition of the great vessels. A previous balloon septostomy (at age two weeks) had resulted in short-term improvement. Therapeutic manoeuvres including digitalis, diuretics and supplementary oxygen did not help. A repeat heart catheterization showed equal atrial pressures and eliminated any chance of improvement from further septostomies. Increasingly severe renal failure as indicated by anuria, hyperkalaemia, urea retention and increasing creatinine levels resulted from the inadequate renal perfusion. Surgical correction of the lesion was considered the only possible way to improve tissue perfusion. Pre-existing severe renal failure suggested profound hypothermia might be contra-indicated as the exsanguination technique may cause renal tubular damage. 2 On the other hand Moyer 3 and Collins 4 suggest that hypothermia affords moderate protection against severe renal damage due to ischaemia. Despite this and tile risk of the postoperative low cardiac output syndrome, 1 the decision was made to proceed with the operation. ANAESTHETIC MANAGEMENT Pre-operative preparation focused on proper fluid, electrolyte and caloric balance. Peritoneal dialysis was used to modify the hyperkalaemia. The serum potassium was reduced from 6.7 meq/L to 4.4 meq/L with a normal pH. No premedication was used. Induction was with oxygen-halothane. The initial halothane concentration of 0.5 per cent was increased gradually to 1.25 per cent as tolerated. Oro-tracheal intubation was performed during spontaneous respiration. Controlled ventilation was then established using nitrous oxide-oxygen (5:3), halothane (0.75--1.0 per cent) and d-tubocurarine. The Jackson-Rees modification of the Ayre's T-piece was employed. The electrocardiogram was monitored; arterial and venous catheters were inserted for sampling and pressure monitoring. Temperature was measured in both oesophagus and rectum and recorded. The infant was cooled on a cooling blanket. The body surface was covered with |
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