Advertisement

Canadian Anaesthetists’ Society Journal

, Volume 24, Issue 4, pp 491–504 | Cite as

Simple deep hypothermia for open heart surgery in infancy

  • Reiji Wakusawa
  • Shigeji Shibata
  • Kazutoshi Okada
Article

Summary

Results of open cardiac surgery under deep simple hypothermia in 121 infants with body weight of less than 10 kg are reported. Deep ether anaesthesia combined with large quantities of ganglion blocking agents (triflupromazine 3 mg/kg) constitutes the anaesthetic management of choice for deep surface-induced hypothermia. The mean lowest oesophageal temperature was 20.8° C, and 18.9° C rectally. The mean circulatory arrest time was 40 minutes. Seventeen infants ( 14.0 per cent) died post-operatively. There were no operative deaths attributable to failure of cardiac resuscitation.

This technique widens the scope of open heart surgery in small infants. Most of the surgically correctable malformations should be operable by this method. More than the potential hazards of hypothermia, which we believe are solved by our technique, the major problem posed by surgery in these small infants is the trans and post-operative respiratory management.

Keywords

Ventricular Septal Defect CANADIAN Anaesthetist Circulatory Arrest Small Infant Deep Hypothermia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Les auteurs rapportent leur expérience de 121 enfants de moins de 10 kilos ( poids moyen: 7.8 kilos), opérés à cœur ouvert, sous hypothermie profonde, au cours des huit dernières années. Quatre-vingt-un de ces enfants étaient de moins ďun an (âge moyen: 12.3 mois).

Ces enfants ont été opérés sous C.E.C., en hypothermie profonde permettant des arrêts circulatoires de 14 à 77 minutes (moyenne: 40 minutes 20 secondes).

Ľhypothermie était produite par immersion en bain ďeau glacée sous ânes thésie profonde à ľéther et sous protection de bloqueurs sympathiques à hautes doses. La moyenne des températures œsophagiennes atteintes se situait à 20.8° C, et celle des températures rectales à 18.9° C.

Aucun décès n’est relié à des causes anesthésiques ou à la réanimation du myocarde. Cependant, les soins post-opératoires respiratoires ont influencé significativement le pronostic. Dix-sept enfants (14 pour cent) sont morts en post-opératoire. p ]Les auteurs concluent que ľhypothermie profonde est une méthode simple pour la chirurgie ouverte des tout jeunes enfants.

References

  1. 1.
    Swan, H., Zeavin, I., Holmes, J.H., &Montgomery, V. Cessation of the circulation in general hypothermia. Ann. Surg.138: 360 (1953).PubMedCrossRefGoogle Scholar
  2. 2.
    Hegnauer, A.H., Shiber, W.J., &Haterus, W.E. Cardiovascular response of the dog to immersion hypothermia. Am. J. Physiol.161: 455 (1950).PubMedGoogle Scholar
  3. 3.
    Kirby, C.K., Jenson, J.M., &Johnson, F. Defibrillation of the ventricles under hypothermic conditions. Arch. Surg.68: 663 (1954).Google Scholar
  4. 4.
    Riberi, A., Siderys, H., &Shaumacker, H.B. Ventricular fibrillation in hypothermic state. Ann. Surg.143: 216 (1956).PubMedGoogle Scholar
  5. 5.
    Ōta, Y., Tsunemoto, M.;Noguchi, T., Shimada, M., Ino, T., RI, M., Iwabori, Y., Tominaga, T., Mikawa, H., Miyasaka, K., Emoto, Y., &Yoshinari, M. Surfaceinduced deep hypothermia and perfusion rewarming for open heart surgery during infancy. Jap. J. Thorac. Surg.26: 153 (1973).PubMedGoogle Scholar
  6. 6.
    Barratt-Boyes, B.C., Simpson, C.H.M.M., &Neutze, J.M. Intracardiac surgery in neonates and infants vising deep hypothermia with surface cooling and limited cardiopulmonary bypass. Circulation 43 (Suppl I): 1–25 (1968).Google Scholar
  7. 7.
    Rittenhouse, E.D., Mohri, H., Dillard, D.H., &Merendino, K.A. Deep hypothermia in cardiovascular surgery. Ann. Thorac. Surg.17: 63 (1974).PubMedGoogle Scholar
  8. 8.
    Wakusawa, R., Shibata, S., Saito, H., Chiba, T., Hosoi, N., Sasaki, T., Okada, K., &Hosoi, Y. Clinical experience in 525 cases of open-heart surgery under simple profound hypothermia. Jap. J. Anesthesiol.18: 240 (1968).Google Scholar
  9. 9.
    Okamura, H. Inhalation anesthesia for simple deep hypothermia induced by surface cooling. Med. J. Osaka Uni.20: 29 (1969).Google Scholar
  10. 10.
    Niitsu, K., Inoue, H., Ara, H., Isono, N., Uchiyama, T., Kumagai, Y., Aoki, T., Endo, K., Hamada, Y., Chiba, T., Hosoi, N., &Miyamoto, A. Clinical application of open-heart surgery using simple deep hypothermia. Surg. Diagno. Treat.13: 624 (1970).Google Scholar
  11. 11.
    Wakusawa, R. Simple deep hypothermia for open heart surgery. Jap. J. Thorac. Surg.25: 322 (1971).Google Scholar
  12. 12.
    Kaneda, M., Wakusawa, R., Okada, K., Ara, H., Tochinai, H., Segawa, Y., Goto, T., Iwabuchi, T., Kawahara, I., &Okuguchi, S. Simple deep hypothermia for open-heart surgery in infancy. Jap. J. Thorac. Surg.27: 1020 (1974).PubMedGoogle Scholar
  13. 13.
    Dillard, D.H. &Mohri, H. Correction of heart disease in infancy utilizing deep hypothermia and total circulatory arrest. J. Thorac. Cardiov. Surg.61: 74 (1971).Google Scholar
  14. 14.
    Steward, D.J., Sloan, I.A., &Johnston, A.E. Anaesthetic management of infants undergoing profound hypothermia for surgical corrections of congenital heart disease. Can. Anaesth. Soc.J.21: 15 (1974).PubMedCrossRefGoogle Scholar
  15. 15.
    Mori, A., Muraoka, R., Yokota, Y., Okamoto, Y., Ando, F., Fukumasu, H., Oku, H., Ikeda, M., Shirotani, H., &Hikasa, Y. Deep hypothermia combined with cardiopulmonary bypass for cardiac surgery in neonates and infants. J. Thoraci. Cardiov. Surg.64: 422 (1972).Google Scholar
  16. 16.
    Subramanian, S., Wagner, H., Vlad, P., &Lambert, E. Surface-induced deep hypothermia in cardiac surgery. J. Pedat. Surg.6: 612 (1971).CrossRefGoogle Scholar
  17. 17.
    New classification of physical status. Anesthesiology24: 111 (1963).Google Scholar
  18. 18.
    Okada, K., Shibata, S., Chiba, T., Hosoi, N., Miyamoto, A., Nishio, S., Tochinai, H., Segawa, Y., &Wakusawa, R. Case report of cardiac arrest caused supposedly by the temperature difference between the rectum and the esophagus. Jap. J. Anesthesiol.21: 389 (1972).Google Scholar
  19. 19.
    Goldberger, E. Unipolar lead electrocardiography and vectrocardiography. Philadelphia: Lea & Febiger (1953).Google Scholar
  20. 20.
    Young, W.G. Jr., Sealy, W.C., Brown, I. W. Jr., Hewitt, W.C., Callaway, H.A., Herritt, D.H., &Harris, J.S. Method for controlled cardiac arrest as adjunct to openheart surgery. J. Thorac. Surg.32: 604 (1956).PubMedGoogle Scholar
  21. 21.
    Seelye, E.R., Harris, E.A., Squire, A.W., &Barratt-Boyes, B.G. Metabolic effects of deep hypothermia and circulatory arrest in infants during cardiac surgery. Brit. J. Anaesth.43: 449 (1971).PubMedCrossRefGoogle Scholar
  22. 22.
    Burton, G.W. Metabolic acidosis during profound hypothermia. Anaesthesia19: 365 (1964).PubMedCrossRefGoogle Scholar
  23. 23.
    Severinghause, J.W. Respiration in hypothermia. Ann. N.Y. Acad. Soci.80: 384 (1959).CrossRefGoogle Scholar
  24. 24.
    Carson, S.A.A. &Morris, L.E. Controlled acid-base status with cardiopulmonary bypass and hypothermia. Anesthesiology23: 618 (1962).PubMedCrossRefGoogle Scholar
  25. 25.
    Murai, M. Study on changes in the coagulation system by thromboelastogram observation during hypothermia. J. Jap. Asso. Thorac. Surg.12: 1021 (1964).Google Scholar
  26. 26.
    Willson, J.T., Miller, W.R., &Eliot, T.S. Blood studies in the hypothermic dog. Surgery43: 979 (1958).PubMedGoogle Scholar
  27. 27.
    Weddel, W.G., Fairley, H.B., &Bigelow, W.G. Improved management of clinical hypothermia based upon related biochemical studies. Ann. Surg.140: 542 (1957).CrossRefGoogle Scholar
  28. 28.
    Blair, E., Montgomery, A.V., &Swan, H. Posthypothermic circulatory failure. Circulation13: 909 (1956).PubMedGoogle Scholar
  29. 29.
    Horiuchi, T., Oyamada, M., Ishidoya, T., Sagawa, Y., Honda, T., Matsumura, M., Tsuda, T., Ishizawa, E., Ishikawa, S., Saito, Y., Matsumoto, T., Tanaka, S., &Okada, Y. Cardiovascular surgery in infancy. Lung & Heart11: 191 (1964).Google Scholar
  30. 30.
    Higasa, Y., Shirotani, H., Satomura, N., Saito, A., Mori, T., &Asawa, Y. Surgical therapy for cardiac disease of infant. Surgical Therapy17: 209 (1967).Google Scholar
  31. 31.
    Kimoto, R., Saito, M., Shioda, Y., Okuyama, T., &Hosoya, T. Cardiac Pacing during hypothermia. J. Jap. Asso. Thorac. Surg.15: 1173 (1967).Google Scholar
  32. 32.
    Mohri, H., Dillard, D.H., &Merendino, K.A. Hypothermia: Halothane anesthesia and the safe period of total circulatory arrest. Surgery 72:345 (1972).PubMedGoogle Scholar
  33. 33.
    Okamura, H. Open-heart surgery under simple deep hypothermia. Geka32: 830 (1970).Google Scholar
  34. 34.
    Okada, K., Takahashi, H., Sato, K., Watabe, Y., &Iwatsuki, K. Hypothermia in the repair of VSD in infancy. Jap. J. Anesthesiol.15: 313 (1966).Google Scholar
  35. 35.
    Hosoi, N., Wakusawa, R., Shibata, S., Chiba, T., Okada, K., Nishio, S., Tochinai, H., Segawa, Y., &Saito, H. Hemodynamic change induced profound hypothermia. Jap. J. Anesthesiol.20: 923 (1971).Google Scholar
  36. 36.
    Edmark, R.W. Continuous blood pH measurement with extracorporeal cooling. Surg. Gynec. Obstet.109: 743 (1959).PubMedGoogle Scholar
  37. 37.
    Shida, H., Morimoto, M., Sugaya, H., Seki, R., &Nemoto, S. Pathogenesis and treatment of metabolic acidosis in open-heart surgery by simple profound hypothermia. Jap. J. Thorac. Surg.26: 335 (1973).PubMedGoogle Scholar
  38. 38.
    Wakusawa, R. Acid base balance during hypothermia. Jap. J. Anesthesiol.21: 930 (1972).Google Scholar
  39. 39.
    Saito, H., Wakusawa, R., Shibata, S., Chiba, T., Hosoi, N., Sasaki, T., &Okada, K. Serum electrolyde change during profound hypothermia. Jap. J. Anesthesiol.18: 1223 (1968).Google Scholar
  40. 40.
    Downes, J.J., Nlcodemus, H.F., Pierce, W.S., &Waldhausen, J.A. Acute respiratory failure in infants following cardiovascular surgery. J. Thorac. Cardiov. Surg.59: 21 (1970).PubMedGoogle Scholar
  41. 41.
    Aberdeen, E. Mechanical pulmonary ventilation in infants tracheostomy and tracheostomy care in infants. Proc. Roy. Soc. Med.58: 900 (1965).PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1977

Authors and Affiliations

  • Reiji Wakusawa
    • 1
  • Shigeji Shibata
    • 1
  • Kazutoshi Okada
    • 1
  1. 1.Department of AnesthesiologySchool of Medicine, Iwate Medical UniversityMonoicaJapan

Personalised recommendations