Asian Cardiovasc Thorac Ann 2002;10:96
© 2002 Asia Publishing EXchange Pte Ltd
Bidirectional Glenn Shunt: 170 Cases
Kanchi Muralidhar, MD
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Department of Cardiac Anaesthesia Narayana Hrudayalaya #258/A Bommasandra Industrial Area Anekal Taluk Bangalore, Karnataka 562158, India
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I was thrilled to read the article by Xie and colleagues.1 Having been associated with the team, I would like to highlight the following points from the anesthetic point of view.
When the superior vena cava (SVC) was clamped without the use of cardiopulmonary bypass, there was an increase in the SVC pressure; the duration of SVC hypertension was limited as our surgeons took 6 to 8 minutes to complete the anastomosis of the SVC and the pulmonary artery. To avoid possible cerebral edema and neurological damage, all patients were given a steroid (30 mg•kg-1 methyl-prednisolone, or 0.5 mg•kg-1 dexamethasone) 30 minutes prior to SVC clamping, and thiobarbiturate (5 mg•kg-1 sodium pentothal administered over 5 to 10 minutes) 5 minutes prior to SVC clamping, as well as mild hyper-ventilation (PaCO2 of 30 mm Hg) and a head-up tilt, before and during the SVC clamping. All patients were electively ventilated for 1 to 2 hours postoperatively; tracheal extubation was performed after confirming intact neurological status. All patients who survived the procedure woke up postoperatively and showed no signs of neurological damage.
REFERENCE
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Xie B, Zhang JF, Shetty DP. Bidirectional Glenn shunt: 170 cases. Asian Cardiovasc Thorac Ann
2001;9:196–9.[Abstract/Free Full Text]
