Propofol infusion syndrome (PRIS) is a serious complication that occurs during propofol infusion. PRIS is a fatal clinical condition that includes hepatomegaly, fatty liver, hyperlipemia, metabolic acidosis, rhabdomyolysis and myoglobinemia. PRIS is possibly developed by the lowered ATP production due to the inhibition of mitochondrial function and fatty acid metabolism. PRIS appears more commonly in children because of their property that metabolism and elimination of propofol are prolonged, according with high dependency on fat metabolism. Safe application of propofol has been indicated as the precise mechanism of PRIS has been clarified.
【Purpose】We aimed to show the safety of on-table extubation in pediatric cardiac surgery without cardiopulmonary bypass (CPB) compared to noncardiac surgery. 【Method】Patients who underwent elective cardiac surgeries without CPB with age ranging from 1 month to 3 months in Mie University Hospital between October and November 2017 were enrolled. The extubation time of cardiac surgery was evaluated compared to noncardiac surgery. 【Result】In total, 12 patients were enrolled in this study (6 were cardiac surgeries, 6 were noncardiac surgeries). There was no difference in extubation time between cardiac and noncardiac surgeries (10.8± 2.6 vs 12.8± 3.7 min, p=0.75). There was neither incidence of re-intubation nor complications associated with epidural anesthesia. 【Conclusion】On-table extubation for pediatric cardiac surgery without CPB is suggested to be performed safely.
Currently, staged Fontan operation in patients with functional single ventricle has been established, however, there exist several failure cases from Fontan track and whose clinical course is not fully understood yet. Although Fontan takedown has been previously described, indication for redo Fontan is clinical issue of Importance and remains controversies. We present a case in which successful redo Fontan completion after meticulous eradicating of collateral vessels following Fontan takedown.
The patient was a 75-year-old female with a history of hypertension and atrial fibrillation. She experienced severe lower abdominal pain and presented to our hospital. The patient was diagnosed as having strangulated ileus by abdominal CT scan and underwent emergency surgery. She was in shock unresponsive to catecholamine the day after the surgery in ICU. Since transthoracic echocardiography (TTE) revealed right ventricular dilatation and left ventricular constriction, pulmonary thromboembolism was suspected. The patient was then placed on extracorporeal membrane oxygenation, following which the hemodynamics improved. Although there were no signs of pulmonary thromboembolism on enhanced CT, TTE performed after hemodynamics stabilization revealed severe aortic stenosis as the cause of low cardiac output. She was discharged 22 days after the surgery. When the patient was not evaluated adequately in emergency, it is necessary to assess repeatedly depending on the alteration of patient status and choose an appropriate treatment.