Variação intraoperatória do sódio sérico e complicações neurológicas pós-operatórias em cirurgia cardíaca pediátrica

Nas cirurgias cardiacas em criancas, a ocorrencia de complicacoes neurologicas posoperatorias representa um risco adicional de morbimortalidade. Ainda que uma parcela significativa dessas complicacoes seja atribuida a lesoes de isquemia e reperfusao cerebral, outros fatores inerentes ao proprio procedimento podem contribuir para o seu desenvolvimento. O sistema nervoso central e particularmente sensivel a mudancas abruptas da osmolaridade plasmatica e variacoes significativas do teor de solutos no plasma pelo emprego de solucoes parenterais com tonicidades diversas sao esperadas no intraoperatorio. O sodio serico e o principal responsavel pela osmolaridade plasmatica e medidas seriadas desse eletrolito durante o procedimento podem indicar tais variacoes. Avaliar a variacao do sodio serico e as taxas de hiper ou hiponatremia no intraoperatorio e de obito, de infeccao e de necessidade de suporte hemodinâmico medicamento conforme a ocorrencia de complicacoes neurologicas no pos‐operatorio de cirurgias cardiacas pediatricas, assim como comparar os tempos de internamento e ventilacao mecânica entre os pacientes que apresentaram, ou nao, tais complicacoes neurologicas. Dados de prontuario foram coletados em uma ficha padronizada com informacoes referentes ao procedimento anestesico‐cirurgico e condicoes perioperatorias dos pacientes. Foram estabelecidas com testes nao parametricos a comparacao dos tempos de ventilacao mecânica e internamento na UTI e no hospital entre os pacientes que apresentaram, ou nao, complicacoes neurologicas, assim como a analise da associacao dessas complicacoes com a ocorrencia de hiponatremia, hipernatremia, morte, infeccao e suporte hemodinâmico medicamentoso no posoperatorio...(AU) In pediatric heart surgery, the occurrence of postoperative neurological complications introduces additional morbidity and mortality risk. Although a significant fraction of these complications can be attributed to cerebral ischemia and reperfusion injury, other factors inherent to the surgery itself might contribute to their occurrence. The central nervous system is particularly susceptible to abrupt changes of the plasma osmolarity, while significant intraoperative variations of the plasma solute concentration is expected due to the use of parental solutions with variable tonicities. The serum sodium concentration is the main determinant of the plasma osmolarity; thus, a serial measurement might reveal its intraoperative variation. The aims were to assess the intraoperative variation of the serum sodium concentration, the rates of hyponatremia, hypernatremia, death, and infection, and the need for pharmacological hemodynamic support as a function of the occurrence of postoperative neurological complications after pediatric heart surgery. Additionally, one aim was to compare the length of hospitalization and mechanical ventilation between the patients with and without such complications. Data on the anesthetic‐surgical procedure and perioperative state of the patients, which were collected from clinical records, were entered in a standard form. A comparison of the length of mechanical ventilation and stay in the intensive care unit (ICU) and the hospital between the patients with and without neurological complications and an analysis of the correlation of these complications with the postoperative occurrence of hypernatremia, hyponatremia, death, infections, and the need for pharmacological hemodynamic support were performed by means of non‐parametric tests...(AU)