Pulse pressure variation is predictive of fluid responsiveness in ventricular septal defect and tetralogy of Fallot patients following cardiac surgery.

Background: Cardiac cycle efficiency (CCE) derived from a pressure-recording analytical method is a unique parameter to assess haemodynamic performance from an energetic view. This study investigated changes of CCE according to an anatomical diagnosis group, and its association with early postoperative outcomes in children undergoing cardiac surgery. Methods: Ninety children were included with a ventricular septal defect (VSD; n¼30), tetralogy of Fallot (TOF; n¼40), or total anomalous pulmonary venous connection (TAPVC; n¼20). CCE along with other haemodynamic parameters, was recorded from anaesthesia induction until 48 h post-surgery. Predictive CCE (CCE p ) was defined as the average of CCE at post-modified ultrafiltration and CCE at the end of surgery. The relationship between CCE and early outcomes was assessed by the comparison between the high-CCE p group (CCE p !75th centile) and the low-CCE p group (CCE p 25th centile). Results: There was a significant time  diagnostic group interaction effect in the trend of CCE. Compared with the high-CCE p group (n¼23), the low-CCE p group (n¼22) required more inotropics post-surgery, had higher lactate concentrations at 8 and 24 h post-surgery, a longer intubation time and longer ICU stay, and higher frequency of peritoneal fluid. Conclusions: Perioperative changes of CCE vary according to anatomical diagnosis in children undergoing cardiac surgery. Children with TOF have an unfavourable trend of CCE compared with children with VSD or TAPVC. A decline in CCE is associated with adverse early postoperative outcomes. Clinical trial registration: ChiCTR1800014996.

A wireless and wearable axillary thermometer (iThermonitor) has been validated for perioperative core temperature monitoring in adults. The purpose of this study was to evaluate its accuracy in pediatrics having non−cardiac surgery. Design: Prospective observational study. Methods: From January 2019 to December 2019, 70 children aged younger than 14 years undergoing surgery in a tertiary hospital were selected. Pairs of esophageal temperatures (T Eso ), rectal temperatures (T Rec ), and axillary temperatures monitored by the iThermonitor (T iTh ) were collected every 5 min during surgery. Taking T Eso as reference, the bias between T Eso and T iTh and the proportion of bias within §0.5°C were calculated. Bland-Altman method was used to analyze the 95% of limits of agreement (LOA) between T iTh and T Eso . The same analyses were done for T Rec. Findings: A total of 2232 pairs of temperatures were collected. The bias (mean § SD) between T iTh and T Eso was -0.07°C § 0.25°C, and 95% LOA was -0.07°C § 0.50°C. The proportion of bias within §0.5°C accounted for 96% (95% Confidence Interval [CI], 92-98%). Higher bias and 95% LOA, and lower proportion of bias within § 0.5°C were found between T Rec and T Eso than those between T iTh and T Eso . Conclusion: During pediatric non−cardiac surgery, axillary temperature derived from iThermonitor is in good agreement with esophageal temperature and can be used as an alternative to core temperature.

Background:Sevoflurane and ketamine are commonly used to obtain sedation and facilitate intravenous anesthetic induction in children undergoing cardiac surgery who are uncooperative. We used a new and direct systemic hemodynamic monitoring technique pressure recording analytical method and compared the hemodynamic effects of sevoflurane and ketamine to facilitate intravenous anesthetic induction.Methods:Forty-four children with ventricular septal defect (2.2 ± 1.2 years) were enrolled and randomized to receive sevoflurane (Group S) or intramuscular ketamine (Group K) for sedation, followed by intravenous midazolam-sufentanil induction and tracheal intubation. Recorded parameters included heart rate (HR), arterial pressures, stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), the maximal slope of systolic upstroke (dp/dtmax) after sedation obtained with sevoflurane or ketamine, 1, 2, 5 minutes after midazolam-sufentanil, 1, 2, 5, and 10 minutes after tracheal intubation. Rate-pressure product (RPP) and cardiac power output (CPO) were calculated.Results:As compared with Group S, Group K had faster decreases during intravenous anesthetic induction in arterial pressures (P < .01 for all), higher HR, arterial pressures, SVRI, dp/dtmax, RPP, lower SVI, CI, CPO (P < .05 for all) during the study period.Conclusion:As compared with sevoflurane, ketamine facilitated intravenous anesthetic induction exerts unfavorable effects on systemic hemodynamic and myocardial energetic in children with ventricular septal defect.

Background: Intravenous sufentanil-midazolam and inhalational sevoflurane are widely used for anesthetic induction in children undergoing cardiac surgery. However, knowledge about their effects on hemodynamics and cardiac efficiency remains limited due largely to the lack of direct monitoring method. We used a minimally invasive technique, the pressure recording analytical method (PRAM), to directly monitor hemodynamics and cardiac efficiency, and compared the effects of the two anesthetic regimens in children undergoing ventricular septal defect repair. Methods: Forty-four children (2.3 ± 0.9 years) were randomized into two groups to receive either intravenous sufentanil (1 µg/kg) and midazolam (0.2 mg/kg) (Group SM) or 2.0 MAC sevoflurane (Group S) to complete induction after sedation was obtained with 2.0 MAC sevoflurane. Systemic hemodynamic data recorded by PRAM included heart rate (HR), systolic (SBP) and mean (MBP) blood pressure, stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), the maximal slope of systolic upstroke (dp/dtmax) and cardiac cycle efficiency (CCE) after sedation obtained; 1, 2, and 5 minutes after induction achieved; 1, 2, 5, and 10 minutes after intubation. Results: HR and SVRI showed a decrease in Group SM but an increase in Group S (Ptime*group < 0.0001) in the study period. SVI and CCE showed an increase in Group SM but a decrease in Group S (Ptime*group < 0.0001). SBP, MBP, and CI were related to time after polynomial transformation, showing an increase after intubation in Group SM but a decrease in Group S (Ptime2*group < 0.0001). Conclusion: PRAM provides meaningful and direct monitoring of hemodynamic parameters as well as cardiac efficiency during the dynamic period of anesthetic induction in children undergoing cardiac surgery. As compared to inhalational sevoflurane, intravenous sufentanil-midazolam exerts more favorable effects on systemic hemodynamics and cardiac efficiency during anesthetic induction in this group of patients.