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Biomedical subjects

Laura K Diaz

Publications and source records attributed to Laura K Diaz.

9 recordsLinked to original sources
PubMed2006

Bilateral monitoring of cerebral oxygen saturation results in recognition of aortic cannula malposition during pediatric congenital heart surgery.

Congenital heart surgery is associated with a 2-25% reported incidence of neurological complication. Near-infrared spectroscopy (NIRS) can detect changes in regional cerebral saturation index (rSO2i) during cardiac surgery. If rSO2i decreases significantly, treatment algorithms are used to restore baseline values, potentially avoiding neurological complications. The efficacy of bilateral NIRS monitoring in pediatric congenital heart surgery has been debated. We report a case in which bilateral NIRS monitoring detected an abrupt decrease in rSO2i (right greater than left) after initiation of bypass without abnormalities detected by standard monitors. This resulted in prompt surgical intervention that restored rSO2i, potentially preventing neurological injury.

Brain Chemistry↗
PubMed2006

Anesthesia and postoperative analgesia in pediatric patients undergoing cardiac surgery.

Pediatric cardiac anesthesiologists care for patients ranging from premature infants weighing <2 kg to adults requiring surgical intervention for congenital heart disease. Along with their cardiac pathophysiologies, many of these patients also have other co-existing diseases that can affect their anesthetic management. Recent advances in monitoring include non-invasive neuromonitors, such as near-infrared spectroscopy and trans-cranial Doppler, which are assuming increasing importance in intraoperative management, particularly during cardiopulmonary bypass. A variety of anesthetic techniques, including regional anesthesia, can be used to facilitate early extubation in older infants and children with stable postoperative hemodynamics. In addition to regional anesthesia, other modalities for the management of postoperative pain include opioid infusions in critically ill children and the use of patient- or nurse-controlled analgesia pumps. Multiple pain assessment tools are available for children of varying ages and developmental levels to assist in providing appropriate postoperative pain management.

Anesthesia↗
PubMed2005

Usefulness of real-time navigator magnetic resonance imaging for evaluating coronary artery origins in pediatric patients.

Navigator coronary magnetic resonance imaging (MRI) was evaluated in assessing coronary artery origins in a pediatric and adolescent population. Sixty-five consecutive infants, children, or adolescents (age range 11 days to 21 years) were referred for MRI evaluations to assess coronary artery origins. Coronary artery origins were unambiguously delineated in 62 of 65 patients. In 3 patients, irregular arrhythmias precluded cardiac gating of the magnetic resonance acquisition. Two patients had anomalous coronary artery origins detected. Twenty-six patients required sedation for the studies. Free-breathing 3-dimensional MRI with real-time navigator correction is a robust method for delineating the coronary artery origins in pediatric and adolescent patients.

Adolescent↗
PubMed2005

New developments in pediatric cardiac anesthesia.

As the practice of pediatric cardiac anesthesia continues to grow, anesthesiologists now routinely care for patients ranging in size from less than 2 kg to more than 100 kg. New clinical and laboratory research has enhanced our understanding of the effects of anesthetic drugs on the pediatric myocardium, and improvements in survival statistics for even the smallest and sickest infants have shifted the emphasis to evaluation of quality of life and neurological outcome in pediatric cardiac patients. The use of circulatory support in infants and children, both for rapid resuscitation and for more chronic indications such as bridge to transplantation, also continues to evolve, with the recent introduction of pulsatile and axial pumps for pediatric use. This article reviews anesthetic agents, bleeding and coagulation, neurological monitoring, and mechanical circulatory support in the treatment of infants and children.

Anesthesia↗
PubMed2005

Tracheoesophageal fistula and associated congenital heart disease: implications for anesthetic management and survival.

BACKGROUND: Infants with tracheoesophageal fistula (TEF) and/or esophageal atresia (EA) frequently have other associated congenital anomalies which can have a significant impact on their anesthetic care and survival to discharge. METHODS: A medical record review and retrospective data analysis were performed in a university affiliated children's hospital of all infants undergoing TEF/EA repair between January 1998 and July 2004. The incidence of intraoperative complications during the TEF repair and overall survival to hospital discharge was compared in two groups of infants: 26 patients with TEF/EA and coexisting congenital heart disease (CHD), and 27 patients with TEF/EA and no CHD. RESULTS: The overall incidence of intraoperative critical events during repair of TEF/EA was significantly higher in infants with associated cardiac pathology (P = 0.003). Six of 53 infants died during hospitalization (overall mortality, 11.3%) and all had associated cardiac pathology. In comparison with nonductal-dependent lesions, the presence of a ductal-dependent cardiac lesion appeared to significantly increase patient mortality (57% vs. 10%, P = 0.028). CONCLUSIONS: Low birth weight (<1500 g) and associated cardiac pathology were found to be independent predictors of mortality in infants undergoing surgery for TEF/EA repair. The presence of a ductal-dependent cardiac lesion further increased the risk of morbidity and mortality, in addition to necessitating special anesthesia considerations.

Anesthesia, General↗
PubMed2004

Changes in respiratory mechanics among infants undergoing heart surgery.

UNLABELLED: Children with excessive pulmonary blood flow (PBF) from congenital heart disease have abnormal respiratory mechanics. Exposure to hypothermic cardiopulmonary bypass (CPB) adversely affects lung function. We designed this study of 106 patients to determine the changes in respiratory mechanics in infants younger than 1 yr undergoing heart surgery. Dynamic respiratory compliance (Cdyn) and total respiratory resistance (Rrs) were measured before surgical incision, after sternal closure in the operating room, and after arrival in the intensive care unit. The following data were recorded: age, weight, preoperative pulmonary infiltrates, preoperative mechanical ventilation, evidence of increased PBF before surgery, duration of CPB, duration of aortic cross-clamp, duration of deep hypothermic circulatory arrest, use of steroids, and volume of ultrafiltrate removed. Repeated-measures analysis of variance with covariate analysis was used to determine the effect of each covariate on Cdyn and Rrs at the three time periods. Rrs improved after cardiac surgery correcting increases in PBF, and this was most pronounced in neonates. Among infants with normal or reduced PBF, cardiac surgery with CPB led to a reduction in Cdyn. We consider that the benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of CPB on respiratory mechanics. IMPLICATIONS: The benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of cardiopulmonary bypass on respiratory mechanics in infants.

Aging↗
PubMed2004

Is bilateral monitoring of cerebral oxygen saturation necessary during neonatal aortic arch reconstruction?

UNLABELLED: In this study, we measured cerebral oxygenation in both cerebral hemispheres by using near-infrared spectroscopy before, during, and after regional low-flow cerebral perfusion (RLFP) to determine whether bilateral monitoring was necessary. Neonates undergoing aortic arch reconstruction with RLFP were studied. The bilateral regional cerebral oxygenation index was measured and recorded at 1-min intervals during the following periods: 1) before bypass, 2) during bypass before RLFP, 3) during RLFP, 4) on bypass after RLFP, and 5) post-bypass. Before bypass and on bypass before RLFP, the correlation (r = 0.979 and 0.852) and agreement (mean bias, right versus left, 0 and +2) between hemispheres were excellent. During RLFP, however, correlation (r = 0.35) and agreement (mean bias of the right versus left side, +6.3) worsened and only partially returned to baseline values after RLFP. Nine of 19 patients had sustained differences in cerebral oxygen saturation of >10%, always with the left side values less than the right. Bilateral monitoring detects desaturation in the left cerebral hemisphere during RLFP. The long-term consequences of lower saturations on the left side of the brain are unclear. IMPLICATIONS: Left-sided cerebral hemisphere oxygen saturation, measured with near-infrared spectroscopy, was less than right-sided cerebral oxygen saturation during regional low-flow cerebral perfusion used for neonatal aortic arch reconstruction.

Aorta, Thoracic↗
PubMed2004

Neurological monitoring for congenital heart surgery.

The incidence of neurological complications after pediatric cardiac surgery ranges from 2% to 25%. The causes are multifactorial and include preoperative brain malformations, perioperative hypoxemia and low cardiac output states, sequelae of cardiopulmonary bypass, and deep hypothermic circulatory arrest. Neurological monitoring devices are readily available and the anesthesiologist can now monitor the brain during pediatric cardiac surgery. In this review we discuss near-infrared cerebral oximetry, transcranial Doppler ultrasound, and electroencephalographic monitors for use during congenital heart surgery. After review of the basic principles of each monitoring modality, we discuss their uses during pediatric heart surgery. We present evidence that multimodal neurological monitoring in conjunction with a treatment algorithm may improve neurological outcome for patients undergoing congenital heart surgery and present one such algorithm.

Adolescent↗