Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

2 results

  • Chapter 13 - Perioperative Monitoring for Congenital Heart Disease Surgery

  • from Part IV - Practice of Neuromonitoring: Cardiac Intensive Care Unit
  • Edited by Cecil D. Hahn, Courtney J. Wusthoff
  • Book:
    Neuromonitoring in Neonatal and Pediatric Critical Care
    Published online:
    08 September 2022
    Print publication:
    15 September 2022, pp 165-180

  • Summary

    Congenital heart disease (CHD) encompasses a large collection of cardiac malformations discovered at or before birth. CHD has an incidence of 4 – 50/1000 live births annually. One quarter of these require surgery shortly after birth. Newborn heart surgery has substantially changed since the modern era began with the adaptation of adult cardiopulmonary bypass (CPB) circuitry for infants. After decades of progress, the center of focus has now shifted from survival to the quality of life following newborn heart surgery (NBHS). Indeed, neurodevelopmental disabilities are now considered the single most common sequela of NBHS. Clinical management in the peri-operative period has a significant impact on the infants’ long-term outcomes. Consequently, neurological monitoring in the congenital heart disease population is increasing worldwide. With so many infants undergoing NBHS, the field of neuromonitoring for these patients is wide. In this chapter, we first review the neurological effects of hypothermia and the actual conduct of newborn heart surgery. We then discuss the indications for neuromonitoring and summarize its findings and outcomes in this unique population.

  • Infiltration of the sternotomy wound and the mediastinal tube sites with 0.25% levobupivacaine as adjunctive treatment for postoperative pain after cardiac surgery*

  • S. Kocabas, D. Yedicocuklu, E. Yuksel, E. Uysallar, F. Askar
  • Journal:
    European Journal of Anaesthesiology / Volume 25 / Issue 10 / October 2008
    Published online by Cambridge University Press:
    01 October 2008, pp. 842-849
    Print publication:
    October 2008
  • Background and objective

    This study aimed to investigate the effect of 0.25% levobupivacaine infiltration of the sternotomy wound and the mediastinal tube sites on postoperative pain, morphine consumption and side-effects in patients undergoing cardiac surgery.

    Methods

    After obtaining Ethics Committee approval and informed consent, 50 patients aged 18–65 yr, undergoing coronary artery bypass grafting, were included in this study. Anaesthesia was induced with 5 μg kg−1 fentanyl, 0.3 mg kg−1 etomidate, 1 mg kg−1 lidocaine, 0.1 mg kg−1 vecuronium and maintained with 1–2% sevoflurane, 50% oxygen in air and fentanyl. Patients were randomized into two groups before sternal wire placement: sternotomy and mediastinal tube sites were infiltrated with either 60 mL 0.25% levobupivacaine (infiltration group, n = 25) or 60 mL saline placebo (control group, n = 25). All patients received intravenous morphine patient-controlled analgesia (bolus dose: 2 mg, lock-out time: 15 min, 4 h limit: 20 mg) after extubation. Postoperative pain at rest and on coughing was assessed by a visual analogue scale (0–10). Pain scores, sedation scores (Ramsay scale), haemodynamic and respiratory parameters, arterial blood gases and morphine consumption were recorded.

    Results

    The times to extubation and visual analogue scale scores were similar between groups. Morphine consumption at 24 h was significantly lower in the infiltration group compared with the control group (29.5 ± 5.1 vs. 42.8 ± 4.7 mg, respectively, P < 0.05). The sedation scores were found to be significantly higher in the control group when compared with the infiltration group at 1, 2 and 4 h after extubation (P < 0.05), whereas sedation scores after 4 h were similar between groups.

    Conclusion

    Infiltration of the median sternotomy incision and the mediastinal tube insertion sites with 0.25% levobupivacaine in addition to morphine patient-controlled analgesia was found to be effective in reducing postoperative morphine consumption when compared with morphine patient-controlled analgesia alone during the initial 24 h after cardiac surgery.