Biomedical subjects

C Ramil Fraga

Publications and source records attributed to C Ramil Fraga.

3 recordsLinked to original sources

PubMed2003

[Early extubation with caudal morphine after pediatric heart surgery].

OBJECTIVES: To analyze the viability of immediate extubation of children after corrective surgery for congenital heart defects with extracorporeal membrane oxygenation using an anesthetic technique involving caudal morphine, and to study the effect on length of stay in the pediatric intensive care unit (PICU) or elsewhere in the hospital. MATERIAL AND METHODS: Twenty-nine ASA I-II patients without coagulation alterations undergoing surgery to correct simple heart defects were selected for extubation after surgery. Anesthesia was provided with with sevoflurane, midazolam, rocuronium, fentanil (maximum dose 10 micrograms/Kg) and a bolus of caudal morphine (50-60 micrograms/Kg) after anesthetic induction. Patient characteristics, type of surgery, times of extracorporeal circulation and of ischemia, arterial blood gases upon arrival in the PICU, postoperative complications and quality of analgesia were the variables analyzed. We also compared length of stay in the PICU and hospital for the study group and for a historical control group of 23 patients who had no received caudal morphine or been selected for early extubation. RESULTS: All patients were extubated satisfactorily in the operating room. None required reintubation or reoperation. Postoperative pain was controlled with metamizol alone for 79.3%. No episodes of respiratory depression or neurological complications were observed. PICU and hospital stays were significantly shorter in the study group than in the control group. CONCLUSIONS: Of patients undergoing simple corrective heart surgery with extracorporeal membrane oxygenation immediate extubation did not increase postoperative morbimortality and shortened the hospital stay. A single dose of caudal morphine provided optimum conditions for extubation and good control of postoperative pain. Strict measures must be taken, however, to avoid postpuncture bleeding.

Analgesics, Non-Narcotic↗

PubMed1996

[Foreign-body aspiration].

Aspiration of foreign bodies is a common accident during childhood. In its diagnosis, both an accurate clinical history and a high degree of suspicion must be taken into account. Without an early diagnosis and its correct treatment, it remains a major cause of morbidity and mortality in children. The objective was to analyze the incidence, diagnosis and therapy of foreign bodies in the airways in pediatric patients. We have conducted a retrospective study of sixty-four patients admitted to our Pediatric Intensive Care Unit during the last eight years with a suspected diagnosis of a foreign body in the airways. Accordingly, we have evaluated the clinical and epidemiological data, as well as the diagnostic and therapeutic methods used. Half of the patients were under two years of age. Cough was a constant finding in all cases. Most of the cases showed air-trapping in chest X-rays, and in almost all cases a bronchoscopy was needed to remove the foreign body. The aspirated material found was mostly frequently found was a piece of food and it was most commonly placed in the main right bronchus. We underline the importance of prevention to avoid this problem by leaving out of the child's reach dry fruits and other small objects that can be easily introduced into their mouths.

Adolescent↗

PubMed1996

[Blunt abdominal trauma. Nonoperative management].

During the 7 year period, 1987 to 1994, 48 patients with blunt abdominal trauma were treated in our Hospital. There were splenic injury in 50% cases, liver trauma in 25% and renal injury in 40%. Seven patients suffered injuries to multiple sites. The clinical findings were confirm with ultrasound (47 children) and Computed Tomography scanning (CT) (19 children). Intravenous pyelography were performed in nine cases with previously suspect of renal affection. The CT scan provided diagnosis in four patients with negative findings in the sonography. In the present serine, 42 cases were managed by nonoperative means with 100% survivals. One patient surgically treated died from associated severe head injury. The postoperative complications appeared in ten nonoperatively cases (recurrence of bleeding in four children). 14 of these non surgical patients required blood transfusion, and the mean volume of transfusion was 30 ml/kg. A follow-up abdominal sonography was obtained in all survivors, showing resolution of the injury in all of them. We conclude that non surgical managements must be the first choice in all blunt abdominal trauma in pediatrics. Laparotomy is mandatory in masive bleeding or hemodynamically inestable patients. Ultrasonography is a simple method without risks and fast available, well indicated for diagnosis and follow-up of this children.

Adolescent↗