Background: To compare and analyze the safety and efficacy of fast-track and conventional anesthesia for transthoracic closure of ventricular septal defects (VSDs) in pediatric patients.
Methods: A total of 82 pediatric patients undergoing transthoracic closure of VSDs between September and December 2017 were retrospectively analyzed. The patients were divided into two groups, including 42 patients in group F (fast-track anesthesia) and 40 patients in group C (conventional anesthesia). The perioperative clinical data of both groups were collected and statistically analyzed.
Results: There were no fatal complications in both groups. No complete atrioventricular block (AVB), new aortic valve regurgitation, and device closure failure were observed. No significant difference was found in preoperative general data or intraoperative hemodynamic changes between the two groups (P >0.05). However, the mechanical ventilation time, length of postoperative intensive care unit (ICU) stay, length of hospital stay, and hospitalization expenses of group F were significantly lower than those of group C (P <0.05).
Conclusion: It is safe and effective to use fast-track anesthesia for transthoracic closure of VSDs in pediatric patients.
We randomly divided 200 children with severe pneumonia who met the indications for tracheal intubation into 2 groups in this prospective study. One group that received dexmedetomidine for sedation was recorded as the dexmedetomidine group (n = 100), and the group that received midazolam for sedation was recorded as the midazolam group (n = 100). We compared the anesthesia sedation scores, time to fall asleep, time to wake up from anesthesia, related hemodynamic parameters, and adverse reactions between the two groups of children. The failure mode and effect analysis method (FMEA) was also used to investigate the causes of unplanned extubation (UEX) of tracheal intubation in 32 children with severe pneumonia. Our conclusion is as follows: (1) Compared with midazolam, the comprehensive effect of dexmedetomidine on children with severe pneumonia undergoing tracheal intubation for anesthesia and sedation is better, it can effectively shorten the anesthesia induction time and the recovery time after stopping the drug, and there are few adverse reactions, which is worthy of application and promotion. (2) UEX is an important risk factor in the monitoring and nursing of children with severe pneumonia tracheal intubation, and the nursing method of PDCA cycle management is particularly important for them.
Objectives
To compare the advantages and disadvantages of perventricular and
percutaneous procedures for treating isolated ventricular septal defect
(VSD).
Methods
A total of 572 patients with isolated VSD were selected in our hospital
between January 2015 and December 2016. The patients’ median age and weight
were five years (1-26 years) and 29 kg (9-55 kg), respectively. The median
diameter of VSD was 6.0 mm (5-10 mm). Patients were divided into two groups.
In group A, perventricular device closure was performed in 427 patients; in
group B, 145 patients underwent percutaneous device closure.
Results
Four hundred twelve patients in group A and 135 patients in group B underwent
successful closure. The total occlusion rate was 98.5% (immediately) and
99.5% (3-month follow-up) in group A, which were not significantly different
from those in group B (97.7% and 100%, respectively). Patients in group A
had longer intensive care unit (ICU) stay than those in group B, but
patients in group B experienced significantly longer operative times than
those in group A. The follow-up period ranged from 8 months to 1.5 year
(median, 1 year). During the follow-up period, late-onset complete
atrioventricular block occurred in two patients. No other serious
complications were noted in the remaining patients.
Conclusion
Both procedures are safe and effective treatments for isolated VSD. The
percutaneous procedure has obvious advantages of shorter ICU stay and less
trauma than the perventricular procedure. However, the perventricular
procedure is simpler to execute, results in a shorter operative time, and
avoids X-ray exposure.
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