Pediatric cardiac postoperative care

Abstract

The Heart Institute of the University of São Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.

Bedside Ultrasound in the Diagnosis and Treatment of Children with Respiratory Difficulty Following Cardiac Surgery

“…These methods permit analysis of cardiac chambers and operative results, detection of residual defects, evaluation of position and function of valvular prosthesis, and estimation of pressures inside cardiac chambers. [ 35 ] The intensivist in PCICU is not always a cardiologist, so it is advised for the intensivist to perform a quick informative US screen to assess at least cardiac function and to rule out PE that may lead to respiratory or hemodynamic failure in many occasions.…”

Mean Arterial Blood Pressure Monitoring Among Pediatric Patients after Open Heart Surgery

“…Sophisticated standard monitoring may be added to facilitate clinical diagnosis and treatment that consists of ECG, temperature probe, central venous pressure and arterial blood pressure (ABP). (2) ABP folds main three components as follow systolic, diastolic and mean arterial pressure (MAP). MAP is the mean pressure averaged over time in the arterial pressure readings.…”

“…(11) Depending on its dose, it raises heart rate and systolic arterial pressure, declines diastolic arterial pressure, and relaxes the peripheral vascular bed. (2,12) The reliability of noninvasive MAP compared with invasive MAP reading has been monitored by many authors in adult patients undergoing cardiac surgery. ( 9,(13)(14)(15) Unluckily, the pediatric patients undergoing cardiac surgery are still a big issue for investigation and monitoring due to the vigorous risks and its difficulties.…”