A retrospective review of 61 cases of airway management for newborn tracheo-oesophageal fistula (TOF)/oesophageal atresia repair is presented. Standard management included induction of general anaesthesia and muscle relaxation before tracheal intubation, rigid bronchoscopy, careful placement of the tracheal tube below the TOF if possible, and occlusion of the fistula with a Fogarty embolectomy catheter in certain high risk cases. Gastrostomy was not routinely performed. Ventilation proceeded without difficulty in 48 cases. Ventilation difficulties were encountered in 13 cases. Eight of the 13 cases had large TOF, and four had other causes of difficult ventilation not related to the fistula. No patient with a small TOF had ventilation problems because of the TOF. Three patients had a large TOF successfully occluded with an embolectomy catheter through the bronchoscope. There were no complications ascribed to this technique. An algorithm is suggested for anaesthetic-surgical airway management in these cases.
Objective
We evaluated ST segment monitoring to detect clinical decompensation
in infants with single ventricle anatomy. We proposed a signal processing
algorithm for ST segment instability and hypothesized that instability is
associated with cardiopulmonary arrests.
Design
Retrospective observational study.
Setting
Tertiary children’s hospital 21-bed cardiovascular intensive
care unit (CVICU) and 36-bed step-down unit.
Patients
Twenty single ventricle infants who received stage 1 palliation
surgery between January 2013 and January 2014. Twenty rapid response events
resulting in cardiopulmonary arrests (arrest group) were recorded in 13
subjects and 9 subjects had no interstage cardiopulmonary arrest (control
group).
Interventions
None.
Measurements and Main Results
Arrest data were collected over the 4-hour time window prior to
cardiopulmonary arrest. Control data were collected from subjects with no
interstage arrest using the 4-hour time window prior to CVICU discharge. A
paired subgroup analysis was performed comparing subject 4-hour windows
prior to arrest (pre-arrest group) with 4-hour windows prior to discharge
(post-arrest group). Raw values of ST segments were compared between groups.
A 3-dimensional ST segment vector was created using 3 quasi-orthogonal leads
(II, aVL, and V5). Magnitude and instability of this continuous
vector were compared between groups.
There was no significant difference in mean unprocessed ST segment
values in the arrest and control groups. Utilizing signal processing, there
was an increase in ST vector magnitude (p = 0.02) and instability (p
= 0.008) in the arrest group. In the paired subgroup analysis, there
was an increase in ST vector magnitude (p = 0.05) and instability (p
= 0.05) in the pre-arrest state compared to the post-arrest state
prior to discharge.
Conclusions
In single ventricle patients, increased ST instability and magnitude
was associated with rapid response events which required intervention for
cardiopulmonary arrest, whereas conventional ST segment monitoring did not
differentiate an arrest from control state.
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