Plateau tetralogy of Fallot _409 Anesthesia

ncycgdxhl · Wysłany: Pią 23:13, 18 Mar 2011

Plateau tetralogy of Fallot Treatment of anesthesia

Xie acidosis and compensatory respiratory alkalosis state, also causing pulmonary vasoconstriction, showed varying degrees of pulmonary hypertension. Early after cardiac surgery significantly increased tissue oxygen consumption, therefore, more likely than the plain after metabolic acidosis, arterial blood gases should be timely investigation to determine whether metabolic acidosis. We take additional compound sodium lactate and sodium bicarbonate to correct hypoxia-induced metabolic acidosis in order to restore normal body vascular resistance (SVR). TOF major pathophysiological change is right to left shunt flow resistance from the part of the right heart and pulmonary vascular outflow tract obstruction, severe hypoxemia led to an increase in red blood cells and blood viscosity increased, with patients with a high plateau region of Myoglobin , high viscosity,[link widoczny dla zalogowanych], hypercoagulable state and pulmonary hypertension and so H], which gives the plateau a number of difficulties caused by anesthesia and positive to be careful anesthetic management. TOF anesthesia is to maintain focus on the plateau intravascular volume and SVR, pulmonary vascular resistance to prevent (PVR) of the increase (such as acidosis or high airway pressure), should try to improve oxygenation induction of anesthesia, if necessary, by intravenous infusion to prevent hemoconcentration. Use of ketamine can increase heart rate, elevated blood pressure, 668 *, increased cardiac output, in order to maintain loop stability, without causing the increase of PVR, is considered to be suitable for cyanotic congenital heart disease based anesthetic J. Anesthesia and surgery in 5 patients had symptoms of hypoxia, the use of morphine and phenylephrine 5ug/kg 0.1-0.2mg/kg to improve circulation pressure, decreased pulmonary vascular resistance, which provide a mild myocardial depression and more slow the heart rate to reduce right to left shunt, symptoms improved. In this group of patients, we found that the plateau is very sensitive to heparin in patients (the mechanism is unclear, pending further study), the amount of heparin injected into normal after 3mg/kg5min, ACT was more than 1750s, the average length of 150s around than the plain; and After the CPB, protamine infusion against heparin, heparin dose and protamine ratio of 1:1-1.5, but ACT is still higher than the normal range. 1 patient died due to protamine allergy, so we injected in the aorta before extubation half dose of protamine, observation of vital signs, skin color, such as changes in the nervous system, without exception,[link widoczny dla zalogowanych], an injection margin. Native or whether the patients moved to high altitude, due to their special physical, narcotic treatment needs to change in a targeted manner, but they need to take into account the physiological differences between the two. Moved out of the pulmonary hypertension in patients with performance (PAP) was, we also enhanced our treatment of this area: the former in the non-CPB hemodynamics and oxygenation abnormalities were not given the special treatment, CPB is still high after the PAP who, in the maintenance of blood pressure stable at the same time,[link widoczny dla zalogowanych], with l% nitroglycerin drip. The native reserves were significantly reduced alkaline body fluids, respiratory alkalosis, metabolic acidosis in patients with blood poisoning is a common feature native. In the absence of hypotension before the start of CPB, the general increase in pre-filled in the appropriate 5% sodium bicarbonate, and after the CPB, with 5% sodium bicarbonate 5-18ml / h infusion, and adjust the dosage according to blood gas results that BE were maintained at 4-5 range. On behalf of the acidosis is difficult to correct than the plain areas, required a long time, the specific reasons to be further explored. Therefore, patients in the plateau region during induction of anesthesia should be long enough oxygen to nitrogen in order to increase patient tolerance to hypoxia, and decreased pulmonary vascular resistance,[link widoczny dla zalogowanych], to reduce right ventricular afterload. Must adhere to the continuing suitability of the expansion,[link widoczny dla zalogowanych], to avoid overloading the right heart, sustained correction acid, continuous application of small doses of epinephrine and other comprehensive measures to maintain and even after CPB postoperative systemic vascular resistance in the normal range and end the cycle stability.