Myocardial Protection in Neonates and Infants: What have we Learnt? Where do we Go?

Airan, SachinTalwar, Vikas K. Keshri, Shiv K. Choudhary and Balram

doi:10.19104/jhc.2015.105

Cited by 5 publications

(10 citation statements)

References 47 publications

(62 reference statements)

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“…(11) Cardiothoracic surgeons performed no developmental surveillance. This is considered a missed opportunity, as they are ideally situated to identify those children at high risk for developmental delays due to cardiac surgery-related factors such as prolonged cardiopulmonary bypass, (18,19) the need for cardiopulmonary resuscitation, (20) post-operative seizures, (21) and prolonged postoperative hospital length of stay. (10) Risk-stratification serves to identify those children with CHD considered to be at high risk for developmental delay, and who should be referred directly for formal developmental evaluation.…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopmental evaluation and referral practices in children with congenital heart disease in central South Africa

Smith¹,

Nel²,

Marais³

et al. 2019

SAHJ

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The guideline is not context-specific and serves as a universal tool to facilitate clinical decision-making based on best practice evidence. (4,11) The guideline uses a riskstratification approach with a clinical algorithm, including a combination of developmental surveillance, screening and evaluation aimed at the early identification of developmental delays. (1,2,4,10) By extension, the successful implementation of the guideline also results in the appropriate referral of children with developmental delays to intervention therapies, including physiotherapy, occupational therapy and speech therapy, as well as for psychological and educational support-to optimise their developmental outcome. (1,12-14

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Section: Discussionmentioning

confidence: 99%

Neurodevelopmental evaluation and referral practices in children with congenital heart disease in central South Africa

Smith¹,

Nel²,

Marais³

et al. 2019

SAHJ

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“…Debate over single dose versus multidose CP has been ongoing with proponents of either strategy. 2 In a previous study, we showed the superiority of a single dose of del Nido (DN) CP over the traditional St Thomas CP. 3 Histidine-tryptophan-ketoglutarate (HTK), first described by Bretschneider in 1975 is an organ preservation solution that might offer myocardial protection lasting up to 3 hours after administration of a single dose.…”

Section: Perspectivementioning

confidence: 99%

“…Since the understanding of the peculiar properties of the pediatric myocardium compared with that of adults, 1 pediatric myocardial protection strategies have evolved with the aim of allowing the surgeon enough time to perform an uninterrupted repair with preservation of myocardial function. 2 Along with hypothermia and adequate venting of the heart, cardioplegia (CP) forms the most important component of any myocardial protection strategy. Debate over single dose versus multidose CP has been ongoing with proponents of either strategy.…”

Section: Perspectivementioning

confidence: 99%

Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegia solutions in pediatric patients undergoing open heart surgery: A prospective randomized clinical trial

Talwar

Chatterjee

Sreenivas

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: We conducted a prospective randomized controlled trial to compare del Nido (DN) and histidine-tryptophan-ketoglutarate (HTK) cardioplegia solution in pediatric patients undergoing intracardiac tetralogy of Fallot repair.Methods: One hundred consecutive patients 12 years of age or younger, undergoing intracardiac repair of tetralogy of Fallot were randomized into DN (n ¼ 50) and HTK (n ¼ 50) groups. Cardioplegia strategy consisted of a single dose of DN (20 mL/kg) or HTK (6 mL/kg/min for 6 minutes). Primary outcome was cardiac index (CI). Secondary outcomes were ventricular arrhythmias post crossclamp release, time to peripheral rewarming, duration of mechanical ventilation, inotropic score, intensive care unit and hospital stay, and serum levels of troponin-I, interleukin-6, and tumor necrosis factor-a. Ultrastructural changes in the myocardium were assessed.

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“…Tracheal intubation (IV) (31) 30 mgÁkg À1 Laryngospasm (IV) (23,33,34) 15 mgÁkg À1 Bronchospasm (IV) (36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) 50-100 mgÁkg À1 + 40-50 mgÁkg À1 Áh À1 Bronchospasm (nebulized) (47)(48)(49)(50)(51)(52)(53)(54)(55) 40 mgÁkg À1 or 150 mg (total dose) Antiadrenergic response Cardiopulmonary bypass (IV) (57-60) 25-50 mgÁkg À1 Long QT syndrome (IV) (61) 30-50 mgÁkg À1 + 5-20 mgÁkg À1 Áh À1 Neonatal pulmonary hypertension (IV) (63) 200 mgÁkg À1 + 20-150 mgÁkg À1 Áh À1 Pheocromocytoma (IV) (64) 30-50 mgÁkg À1 + 5-20 mgÁkg À1 Áh À1 Organ protection Neuroprotection (IV) (68-72) 250 mgÁkg À1 Áday À1 Myocardial protection (cardioplegia) (73,74) 40-80 mgÁkg À1 Hypomagnesemia Perioperative hypomagnesemia (IV) (58,59) 25-50 mgÁkg À1 AE 5-20 mgÁkg À1 Áh À1 alveolar concentration by 50% and the induction dose of propofol; it shortens the latency time until a bispectral index value <60 is reached; and it reduces ventilation requirements (tidal volume and respiratory rate) as metabolism decreases (O 2 consumption and CO 2 production) (2,6). Sevoflurane has certain excitatory effects on the central nervous system, which may be associated with increased seizure activity in children.…”

Section: Muscle Relaxationmentioning

confidence: 99%

“…‘Traditional’ calcium channel blockers have a reduced and prolonged effect in children, which can lead to myocardial depression in the postoperative period. The optimal MgSO 4 concentration in cardioprotective cardioplegia is 2–4 g·l −1 (2–4 mg·ml −1 ), starting with a bolus dose of 20 ml·kg −1 , equivalent to 40–80 mg·kg −1 of MgSO 4 .…”

Section: Magnesium Sulfate In Pediatric Anesthesiamentioning

confidence: 99%

Magnesium sulfate in pediatric anesthesia: the Super Adjuvant

Rebollar¹,

Palacios²,

Guerrero³

et al. 2017

Paediatr Anaesth

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Magnesium is an essential chemical element in all organisms, intervening in most cellular enzymatic reactions; thus, its importance in homeostasis and as a therapeutic tool in highly challenging patients such as pediatrics. The primary purpose of this paper was to review the role of magnesium sulfate as an adjuvant drug in pediatric anesthesia. This compound already has the scientific backing in certain aspects such as analgesia or muscle relaxation, but only theoretical or empirical backing in others such as organ protection or inflammation, where it seems to be promising. The multitude of potential applications in pediatric anesthesia, its high safety, and low cost make magnesium sulfate could be considered a Super Adjuvant.

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Myocardial Protection in Neonates and Infants: What have we Learnt? Where do we Go?

Cited by 5 publications

References 47 publications

Neurodevelopmental evaluation and referral practices in children with congenital heart disease in central South Africa

Neurodevelopmental evaluation and referral practices in children with congenital heart disease in central South Africa

Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegia solutions in pediatric patients undergoing open heart surgery: A prospective randomized clinical trial

Magnesium sulfate in pediatric anesthesia: the Super Adjuvant

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