Predictors of procedural complications in adult Fontan patients undergoing non-cardiac procedures
Alexander C. EgbeArooj R. KhanNaser M. AmmashDavid W. BarbaraWilliam C. OliverSameh M. SaidEmmanuel AkintoyeCarole A. WarnesHeidi M. Connolly
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Abstract:
Objective
Limited data exist regarding the outcomes of non-cardiac procedures (NCPs) in adult patients after Fontan operations (Fontan patients).Methods
To compare procedural outcomes after NCPs in Fontan patients with outcomes for two matched control groups: patients with repaired congenital heart disease and biventricular circulation (CHD-BiV) and patients with no heart disease (NHD). We defined cyanosis as oxygen saturation <90% and procedural hypoxia as saturation <80% or a decrease in saturation >10% from baseline.Results
There were 538 NCPs in 154 Fontan patients (mean age, 30 years) performed in 1990–2015. Sedation and anaesthesia types were monitored anaesthesia care (256,48%), general anaesthesia (51,9%), minimal sedation (105,20%), local anaesthesia (75,14%) and regional anaesthesia (51,9%). Ninety-three complications occurred in 79 procedures (15%) and included arrhythmia requiring intervention (9), hypotension (14), bradycardia (8), hypoxia (38), heart failure requiring intravenous diuretics (2), acute kidney injury (3), bleeding requiring blood transfusion (1), unplanned procedures for dialysis catheter placement (2), readmission (2), unplanned hospitalisation for hypoxia (8) and unplanned transfer to intensive care unit (1). Baseline cyanosis was the only multivariable risk factor for complications (HR, 1.87 (95% CI 1.14 to 3.67), p=0.04). Procedural complications were more common in the Fontan group (18%) than in the CHD-BiV (5%) and NHD groups (1.4%) (p=0.001).Conclusions
Complications after NCPs were more common in Fontan patients, and baseline cyanosis was a risk factor for complications. All-cause mortality was low and may be related to the multidisciplinary care approach used for Fontan patients at our centre.Keywords:
Fontan Procedure
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Laryngospasm
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Introduction: This study’s aimed to investigate bradycardia after dexmedetomidine infusion during 33℃ target temperature management. Material & Methods: A retrospective study’s conducted on patients underwent 33℃ target temperature management. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated bradycardia. Results: A total of 85 patients were selected, of which 17 were excluded. Among 68 patients, 39 showed bradycardia, 56 were administered with dexmedetomidine. Odds ratio for bradycardia of CO poisoning group over cardiac arrest group and for weight (kg) were 7.448 (95% CI 1.834-30.244, p=0.005) and 1.058 (95% CI 1.002-1.123, p=0.044) respectively. In the bradycardia group with dexmedetomidine, infusion rate of dexmedetomidine was 0.41±0.15 (μg/kg/h). Decisions of charged doctor’s were 1) slowing infusion rate 2) stopping infusion or giving atropine. All cases need no cardiac pacing and didn’t worsen to asystole. Conclusion: Despite of the frequency, bradycardia was recovered after reducing infusion rate. However, lowering infusion rate of dexmedetomidine should be needed to prevent bradycardia from developing in patients with heavy weight, CO poisoning during 33℃ targeted temperature management.
Dexmedetomidine
Asystole
Targeted temperature management
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This study aimed to determine the success rate of sedation-free upper gastrointestinal (GI) endoscopy and evaluate the cost-effectiveness of this drug-free approach.The study included patients who underwent gastroscopy between February 2020 and December 2022. Demographic information such as age and gender, along with clinical data including whether the procedure was performed with sedation and the patients' tolerance status, were recorded. Statistical analysis revealed no significant difference between the sedation and sedation-free groups in terms of procedural success. Interestingly, a notable cost difference of 43% was observed between the two groups, with the sedation-free group demonstrating higher cost-effectiveness. Despite the nearly 50% higher cost associated with administering sedation, there was no significant disparity in the successful completion of the procedure between the two groups. The findings of this study indicate that sedation-free upper GI endoscopy can achieve comparable success rates to the sedation-assisted approach. Moreover, the cost-effectiveness analysis highlights the economic advantage of the drug-free alternative, given the substantial cost reduction observed in the sedation-free group. This study underscores the feasibility of implementing sedation-free procedures as a cost-effective and successful option for upper GI endoscopy
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Objective: CT of the chest in paediatric patients often requires sedation or general anaesthesia to minimize motion artefacts. Both sedation and general anaesthesia are associated with atelectasis which obscures the underlying pulmonary pathology. We conducted a prospective study to compare these two methods with respect to degree of motion artefacts and extent of atelectasis Material and Methods: Nineteen patients undergoing 22 chest CT examinations were randomly selected for either sedation or general anaesthesia. The total area of atelectasis and the degree of motion artefacts were measured Results: The mean percentage of atelectasis was 6.67% for general anaesthesia and 0.01% for sedation ( p=0.01). There was no significant difference in the quality of the images between the sedation patients and the general anaesthesia patients Conclusion: Whenever the clinical condition permits it, sedation rather than general anaesthesia should be given to paediatric patients undergoing chest CT
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Sedation is one of ICU routine treatment, understand the harm to patients caused by deep sedation; by enhancing the ability to regulate the sedation nurse, to help early shallow sedation for goal orientation in the implementation of the program is to reduce sedation, sedation complications, effective means of preventing excessive sedation, is an important measure to promote the development of clinical nursing.
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Nurses; Conscious sedation; Deep sedation; Sedation
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