OBJECTIVE: To assess the relationship between the age of pediatric patients and the likelihood of difficult intubations and to confirm the importance of Down Syndrome causing difficult intubations. DESIGN: Retrospective study. SETTING: Pediatric cardiac surgery operating room. PATIENTS: 627 pediatric patients, suffering from congenital heart disease, operated in our hospital from 1992 to 1994, divided in three age groups (under 1 month, between 1 month and 1 year, over 1 year of age). INTERVENTIONS: Translaryngeal intubation performed in the operating room before the operation. MEASUREMENTS: The percentage of difficult intubations was assessed in the three age groups and the association with Down syndrome was also considered. The likelihood of orotracheal intubations in each of the preceding groups was also examined. CONCLUSIONS: The percentage of difficult intubation in our experience was estimated to be 4.62%. Intubation's difficulty increases with decreasing age of non Down patients. The risk of difficult intubation in Down patients is, irrespectively of age, nearly 27% higher than in non-Downs (5.77% versus 4.52). However Down Syndrome seems to be important only in the age group between one month and one year. The percentage of orotracheal intubations in the preceding groups, even if indirectly, seem to confirm this observation.

Age Factors↗

PubMedDate not supplied

[Enoximone in weaning from mechanical circulation support in pediatric patients].

OBJECTIVE: To assess and record the response to continuous infusion of the phosphodiesterase inhibitor enoximone during weaning from mechanical circulatory support (MCS) and to verify the possibility of success with this indication in pediatric patients. DESIGN: Retrospective study. SETTING: Pediatric cardiac surgery intensive care unit. PATIENTS: Two pediatric patients operated for complex congenital heart disease with low cardiac output syndrome in the immediate postoperative period, evolved in cardiocirculatory arrest despite massive inotropic pharmacological support, and then assisted by mechanical circulatory support. INTERVENTIONS: Weaning from mechanical circulatory support with continuous infusion of enoximone, only in one case preceded by a loading dose and associated with catecholamine infusion. MEASUREMENTS AND MAIN RESULTS: During weaning hemodynamic parameters (LAP, CVP, MAP, HR), SvO2, diuresis, rectal and cutaneous temperatures were assessed and recorded. A serial echocardiographic assessment of left ventricular systolic and diastolic diameters and ejection fraction (EF%) has also been performed every 12 hours. Weaning from MCS using enoximone as inotropic support was possible in both cases. CONCLUSIONS: Enoximone proved to be useful in weaning from MCS in two pediatric patients, despite the difficulty to assess its effect in one of the two cases in which enoximone was used together with high dosages of other inotropic drugs. These initial positive results urge us to further investigate applications of this drug in pediatric patients.

Assisted Circulation↗