RESUMEN
Complications in paediatric anaesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with smell patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of cases malpractice claims. Both minor & major complication occurs most commonly in infants and children under three especially those with severe co-morbidities. Knowledge of risk profiles in paediatric anaesthesia is a starting point for the reduction of risk complication.
Asunto(s)
Anestesia General , Paro Cardíaco , Mala Praxis , Anestesia General/efectos adversos , Niño , Paro Cardíaco/etiología , Humanos , Lactante , MorbilidadRESUMEN
Transient asystole is often noted during the course of permanent pacemaker implantation in patients with complete heart block. Since subcutaneous lidocaine is frequently used as the local anesthetic agent for permanent pacemaker implantation, the effect of this drug on ventricular escape intervals was studied. Ventricular escape intervals after transient cessation of pacing were studied in 9 patients with complete heart block before and 10, 30, and 45 minutes after subcutaneous lidocaine administration for permanent pacemaker implantation. The total lidocaine dose ranged from 170 to 400 mg (1.9 to 9.5 mg/kg of body weight). Therapeutic blood levels were achieved in 7 patients. The mean ventricular escape interval before lidocaine was 1.83 +/- 0.32 seconds, which increased to 2.58 +/- 1.35, 2.96 +/- 1.06, and 2.68 +/- 1.27 seconds at 10, 30, and 45 minutes after lidocaine (p less than 0.02). The mean maximal escape interval before lidocaine was 2.06 +/- 0.30 seconds, which increased to 3.80 +/- 1.44 seconds (p less than 0.01), a mean increase of 84%. The percent increase in maximal escape interval was related directly to the peak lidocaine level achieved. After lidocaine administration, 5 patients had asystole greater than 4 seconds and 1 required resumption of pacing. Thus, subcutaneous lidocaine contributes to the occurrence of asystole seen during permanent pacemaker implantation. It is advisable to limit the amount of lidocaine administered during permanent pacemaker implantation to the minimum necessary to achieve adequate local anesthesia. Strong consideration should be given to the use of a temporary pacemaker in patients with complete heart block during permanent pacemaker implantation even in the absence of previous asystole.
Asunto(s)
Arritmias Cardíacas/inducido químicamente , Paro Cardíaco/inducido químicamente , Bloqueo Cardíaco/terapia , Lidocaína/efectos adversos , Marcapaso Artificial , Anciano , Anestésicos Locales/efectos adversos , Relación Dosis-Respuesta a Droga , Electrocardiografía , Paro Cardíaco/diagnóstico , Bloqueo Cardíaco/fisiopatología , Ventrículos Cardíacos/efectos de los fármacos , Ventrículos Cardíacos/fisiopatología , Humanos , Lidocaína/sangre , Persona de Mediana EdadRESUMEN
A vein holder is described that is used for anastomosis of both ends of aortocoronary bypass grafts. It minimizes handling of the graft, ensures precision in placing sutures with excellent visualization, and provides maximum patency at the anastomotic sites.