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Hormonal and metabolic responses were measured in 15 neonates who underwent repair of complex congenital heart defects during a standardized anesthetic protocol. Four of the 15 neonates died postoperatively in the intensive care unit. Analysis of arterial plasma samples obtained before, during, and 24 h after surgery showed that plasma epinephrine,(More)
The technique of transcatheter ventricular septal defect (VSD) device closure may be associated with significant hemodynamic instability. The anesthetic records and catheterization data of 70 consecutive transcatheter VSD closures between February 1989 and September 1992 were reviewed, and risk factors associated with hemodynamic instability evaluated. In(More)
After repair of congenital heart defects, stress responses in the pulmonary circulation of fourteen infants produced by a brief endotracheal suctioning procedure were studied before and after fentanyl (25 micrograms/kg). The total time of disconnection from the ventilator with suctioning (FIO2 1.0) was limited to no more than 15 sec to avoid alveolar(More)
We conducted a retrospective study of 78 patients who underwent palliative reconstructive operation for hypoplastic left heart syndrome representing an entire consecutive experience between 1983 and 1991 to identify predictors of mortality that might enable more appropriate triage of patients to either reconstruction or transplantation. Twenty-nine patients(More)
The safety and efficacy of fentanyl-oxygen (50 and 75 micrograms/kg) and sufentanil-oxygen (5 and 10 micrograms/kg) were studied in 40 infants undergoing repair of complex heart defects. When fentanyl or sufentanil was given simultaneously with pancuronium, induction of anesthesia was rapid and smooth with only mild and clinically insignificant hemodynamic(More)
Pulmonary and systemic hemodynamic responses to fentanyl were studied in 12 infants after repair of congenital heart defects. During controlled ventilation, hemodynamic responses to 25 micrograms/kg of fentanyl were measured. No significant changes were found in heart rate, cardiac index, mean pulmonary artery pressure, or pulmonary vascular resistance(More)
Avoidance of ketamine has been recommended in children with pulmonary hypertension or with limited right ventricular reserve, despite absence of data about the effects of ketamine on pulmonary vascular resistance (PVR) in children. Ketamine has been associated with increased PVR in studies of adults; in these studies adults were spontaneously breathing(More)
The hemodynamic response to 50% nitrous oxide was studied in 12 sedated but responsive infants in the intensive care unit following repair of their congenital heart disease. One-half of the infants studied had an elevated pulmonary vascular resistance index (PVRI greater than 3.5 Wood units). During mechanical ventilation with a fractional inspired O2(More)
After Norwood's initial report of successful first-stage palliation of hypoplastic left heart syndrome in neonates, an improved understanding of both the pathologic anatomy and physiology of this common condition has led to improving surgical results. Twenty-five neonates have been treated by modifications of the Norwood procedure, and the early mortality(More)