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Biomedical subjects

Emad Mossad

Publications and source records attributed to Emad Mossad.

9 recordsLinked to original sources
PubMed2006

Monitoring cerebral oxygenation in a pediatric patient undergoing surgery for vascular ring.

Regional cerebral oxygenation can be monitored using near-infrared spectroscopy (NIRS). Inadequacy of collateral cerebral circulation and regional cerebral ischemia during cardiac and vascular surgery may be detected by the use of NIRS monitoring. We report a 2-year-old child who underwent surgical repair of vascular ring and subclavian reimplantation, where use of NIRS helped in early detection and timely intervention to prevent prolonged cerebral ischemia.

Brain↗
PubMed2005

Changing of an anesthesiology clinical base year to create an integrated 48-month curriculum: experience of one program.

To allow for growth in our anesthesiology residency, we assumed control of the clinical base year (postgraduate year 1[PGY-1]) and adjusted the curriculum to accommodate the expanded size. With this opportunity to change the curriculum, we created a clinical base year to prepare PGY-1 for clinical anesthesia training in PGY-2 to PGY-4 using, for this purpose, the best resources of our clinical site. We describe the process and preliminary results of the change.

Anesthesiology↗
PubMed2005

Comparison of phenoxybenzamine to sodium nitroprusside in infants undergoing surgery.

OBJECTIVES: The purpose of this study was to compare the effects of a direct-acting arterial dilator, sodium nitroprusside, to an alpha-adrenergic receptor blocker, phenoxybenzamine, in infants with congenital heart defects undergoing cardiac repairs on cardiopulmonary bypass. DESIGN: A prospective, multicenter, observational study. SETTING: Tertiary care center. PARTICIPANTS: Sixty infants scheduled for elective congenital cardiac surgery repair requiring cardiopulmonary bypass. INTERVENTIONS: Patients received either sodium nitroprusside 2 to 5 microg/kg/min infusion intraoperatively and in the intensive care unit (n=30 patients) or received phenoxybenzamine 1 mg/kg slowly intravenously at the onset of cardiopulmonary bypass (n=30 patients). MEASUREMENT AND MAIN RESULTS: Despite similar mean arterial pressures during cardiopulmonary bypass in both groups, infants who received phenoxybenzamine had a significantly higher flow compared with those who received sodium nitroprusside (180+/-4.8 v 73+/-5.12 mL/kg/min, p<0.0001). Base deficit was significantly larger in the sodium nitroprusside group compared with the phenoxybenzamine group intraoperatively and postoperatively (3.4+/-0.5 v 1.3+/-0.5 mEq/L, p<0.05). The core-to-peripheral temperature gradient was significantly larger in the sodium nitroprusside group compared with the phenoxybenzamine group intra- and postoperatively at all points studied. In the intensive care unit, the left atrial pressure was significantly higher in the sodium nitroprusside group compared with the phenoxybenzamine group (9+/-0.4 v 7+/-0.4 mmHg, p<or=0.0005). CONCLUSION: The use of phenoxybenzamine can maintain organ perfusion on cardiopulmonary bypass and improve peripheral circulation as shown by less base deficit and smaller temperature gradients intraoperatively and in the intensive care unit better than nitroprusside.

Cardiopulmonary Bypass↗
PubMed2005

Unexpected ST segment changes in children--a case report.

In children, myocardial ischemic changes during anesthesia are a rare event unless there is underlying pathology. The patient in this case report was an apparently healthy child scheduled for adenoidectomy and bilateral tympanostomy. Occurrence of significant ST changes as well as intraoperative and postoperative hypoxemia required further diagnostic work-up. Postoperative echocardiographic findings were suspicious of intrapulmonary right to left shunting. The pulmonary arteriovenous fistula is probably the major pathophysiological factor for the development of hypoxemia and paradoxical air embolism especially during positive pressure ventilation in our patient. Unexpected ST segment changes might also occur in patients with anomalous origin of coronary arteries. Although diagnostic work-up was inconclusive, it is necessary to rule out any underlying pathological process. Further follow-up is also important in order to learn more about these disease states that often have subclinical, but potentially fatal presentation.

Adenoidectomy↗
PubMed2004

Effectiveness of a circulating-water warming garment in rewarming after pediatric cardiac surgery using hypothermic cardiopulmonary bypass.

OBJECTIVE: To evaluate the effectiveness and safety of the ALLON 2001 microprocessor-based thermoregulation system in pediatric patients undergoing cardiac surgery requiring hypothermic cardiopulmonary bypass compared with the routine thermal care. DESIGN: Prospective randomized clinical study. SETTING: Single tertiary academic medical center. PARTICIPANTS: Infants (0-1 year) who underwent congenital heart surgery requiring hypothermic cardiopulmonary bypass (n = 18). Patients with open wounds and/or patients treated with an investigational drug or device within 30 days of surgery were excluded. INTERVENTIONS: Randomized use of thermoregulation system (warming garment, n = 9) or routine thermal care (control, n = 9) after separating from cardiopulmonary bypass until the arrival to the pediatric intensive care unit (PICU). MEASUREMENTS AND MAIN RESULTS: There were no statistically significant differences in the demographic data, cardiopulmonary bypass time, operating room time, incidence of deep hypothermic circulatory arrest, and cooling temperature between the groups. The nasopharyngeal temperature was significantly higher in the warming garment group after separation from cardiopulmonary bypass. Nasopharyngeal temperature at 20 minutes was 36.5 degrees C versus 35.01 degrees C (p = 0.0047), at 40 minutes was 36.98 degrees C versus 35.30 degrees C (p = 0.034), and at admission to the PICU was 36.09 degrees C versus 35.31 degrees C (p = not significant). There was no difference in the core-to-peripheral temperature gradient (nasopharyngeal-to-skin temperature) between the 2 study groups at any time point. No adverse events related to the use of the warming garment thermoregulation system were observed. CONCLUSION: The investigated thermoregulation system was effective in preventing the after-drop of temperature that occurs after cardiopulmonary bypass in small infants compared with routine warming methods.

Body Temperature↗
PubMed2002

Diverticulum of Kommerell: a review of a series and a report of a case with tracheal deviation compromising single lung ventilation.

IMPLICATIONS: Birth defects can affect the great vessels of the aorta and its branches, compressing the upper airway and the swallowing track. Surgical repair of these defects requires manipulating the airway to improve surgical exposure. This is a report of a series of cases with compromised airway resulting from such a birth defect and methods of its management.

Diverticulum↗
PubMed2002

A glial-derived protein, S100B, in neonates and infants with congenital heart disease: evidence for preexisting neurologic injury.

UNLABELLED: The glial-derived protein S100B is a serum marker of cerebral ischemia and correlates with negative neurological outcome after cardiopulmonary bypass (CPB) in adults. We sought to characterize the S100B release pattern before and after CPB in neonates and infants with congenital heart disease and correlate it with surgical mortality. Serum was collected before surgery and at 24 postoperative h from 109 neonates and infants with congenital heart disease. All patients had presurgical transthoracic echocardiograms and CPB with or without hypothermic circulatory arrest. S100B concentrations were determined using a two-site immunoluminometric assay (Sangtec 100). Thirty-day surgical mortality was observed. All neonates had significantly increased S100B concentrations before surgery that decreased by 24 postoperative h. Preoperative S100B concentrations in 32 neonates with hypoplastic left heart syndrome correlated inversely with the forward flow and size of the ascending aorta and postoperative mortality (r(2) = -0.63; P = 0.03). Among infants, increased pulmonary blood flow was associated with higher S100B levels before surgery than cyanosis. There was no correlation with postoperative S100B and time on CPB, hypothermic circulatory arrest, or 30-day surgical mortality. In conclusion, preoperative S100B concentrations correlate inversely with the size of the ascending aorta in hypoplastic left heart syndrome and may serve as a marker for preexisting brain injury and mortality. IMPLICATIONS: Neonates with hypoplastic left heart syndrome and no forward flow in the ascending aorta may have brain injury at birth before heart surgery.

Aorta, Thoracic↗