A síndrome do coração esquerdo hipoplásico não constitui fator de risco para operação de FontanThe hypoplastic left heart syndrome is not a risk factor for Fontan operation Results: Patients in group A had a mean age of 6.47 years ± 4.83 and those in group B of 2.08 years ± 0.24 P <0.001, the average weight was 22.42 ± 11.04 against 12.99 ± 1.2 P = 0.016, the mean CPB time was 119.5 min against 113.3 min P = 0.0 with an average time of clamping of 74.8 min and 73.5 min P = 0.75. The mean ICU stay was 4.1 days for group A against 7.52 days for the group B P = 0.0003. In total (group A + B), three patients died, with a hospital mortality of 3.9%, being one patient with HLHS (1.3%) (P <0.001, 95% CI 0.001 to 0.228).Conclusion: Our study shows that despite higher morbidity, the HLHS is not a risk factor for hospital mortality. 507SOUZA, AH ET AL -The hypoplastic left heart syndrome is not a risk factor for Fontan operation Bras Cir Cardiovasc 2010; 25(4): 506-509 Rev
Introduction The delayed extubation of patients undergoing mechanical ventilation (MV) in the postoperative period of cardiac surgery (CS) is associated with mortality. The adoption of spinal anesthesia (SA) combined with general anesthesia in CS influences the orotracheal intubation time (OIT). This study aims to verify if the adoption of SA reduces the time of MV after CS, compared to general anesthesia (GA) alone. Methods Two hundred and seventeen CS patients were divided into two groups. The GA group included 108 patients (age: 56±1 years, 66 males) and the SA group included 109 patients (age: 60±13 years, 55 males). Patients were weaned from MV and, after clinical evaluation, extubated. Results In the SA group, considering a 13-month period, 24% of the patients were extubated in the operating room (OR), compared to 10% in the GA group ( P =0.00). The OIT was lower in the SA group than in the GA group (SA: 4.4±5.9 hours vs . GA: 6.0±5.6 hours, P =0.04). In July/2017, where all surgeries were performed in the GA regimen, only 7.1% of the patients were extubated in the OR. In July/2018, 94% of the surgeries were performed under SA, and 64.7% of the patients were extubated in the OR ( P =0.00). The OIT on arrival at the intensive care unit to extubation, comparing July/2017 to July/2018, was 5.3±5.3 hours in the GA group vs . 1.7±3.9 hours in the SA group ( P =0.04). Conclusion The adoption of SA in CS increased the frequency of extubations in the OR and decreased OIT and MV time.
INTRODUCTION: The use of a cycle ergometer for the upper limbs may contribute to maintain the functional capacity in patients after heart surgery (HS). OBJECTIVES: To investigate the cardiorespiratory responses of HS patients receiving or not vasoactive drugs (VADs) during the realizations of cycle ergometer for upper limbs, verifying the incidence of loss of radial arterial catheter or of steel wire fractures in the sternum. MATERIAL AND METHODS: A pilot study involving 26 patients divided in 2 groups. Group CO: no use of VADs (13 patients, age: 57±12 years, 09 male) and VAD group: (13 patients, age: 61±10 years, 07 male), submitted to HS, which on the first postoperative day (1stPO) performed the cycle ergometer for upper limbs. The parameters evaluated during the exercise were heart rate (HR), oxygen saturation (SpO2), dyspnea, fatigue of upper limbs and mean arterial pressure (MAP). The incidence of losses of the radial artery catheter and of steel wire fractures in the sternum was calculated. Statistical analysis adopted one-way or two-way analysis of variance, with post hoc from Newman Kauls or Scheffé, when necessary. The significance level was 0.05%. RESULTS: HR increased in both groups at the end of the exercise (p=0.00), with no difference between them (p=0.97); SpO2, dyspnea and MAP did not change from rest to the end of exercise (p=0.49; p=0.78 and p=0.25, respectively); The fatigue in the upper limbs increased in both groups (p=0.04), without difference between groups (p=0.79); There was no event of loss of radial artery catheter or steel wire fractures in the sternum. CONCLUSION: The adoption of the cycle ergometer for upper limbs was safe in the 1stPO of HS, even in the individuals using VADs. There was no relationship between the use of the upper limbs cycle ergometer and losses of arterial catheters or steel wire fractures in the sternum.
BACKGROUND AND OBJECTIVES: Persistence of pain in the postoperative thoracic region is very common with conventional analgesia performed only with opioids, which prolongs recovery, increasing costs and morbidity. Erector spinae plane blockage is a promising technique for the analgesic control in the postoperative period of cardiac surgeries. The purpose of this study was to describe a case in which erector spinae plane blockage provided adequate postoperative analgesic control. CASE REPORT: A 61-year-old male patient submitted to elective cardiac surgery for left ventricular aneurysmectomy and coronary artery bypass grafting. On the first postoperative day presented pain of intensity 8 on the visual analog scale in the left hemithorax. The patient underwent erector spinae plane blockage with a catheter located at T5 guided by ultrasound with a 17G Tuohy needle and injection of 20mL of 0.5% ropivacaine providing important decrease and improvement of pulmonary expansibility. CONCLUSION: Erector spinae plane blockage provided adequate analgesia and was considered a good therapeutic option.
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