[Postoperative inotropic treatment in cardiac surgery of the newborn infant and infant].
Corrective cardiac surgery in infants and neonates induces acute circulatory and anatomical changes which, together with the myocardial ischaemia of cardiopulmonary bypass, impair cardiac function. Although this cardiac dysfunction usually disappears without any after-effects, inotropic treatment is mandatory for a short time. There, however, is no easy way to monitor cardiac output in these small patients. Neither is there much universally recognized objective data available to help choose between these drugs available or between different protocols. Physiologically, infants are not small adults. In the neonatal period, the heart works virtually at its maximum, with little reserve : the stroke volume has a limited capacity to increase because of poor compliance, and the heart rate is high. Cardiac output is therefore rate dependent. To improve therapeutic adjustment, an attempt is made to rationalize the use of inotropic drugs in the postoperative period. Cardiac dysfunction can frequently be recognized already in theatre. It is of paramount importance to exclude faulty surgical repair by measuring the pressures and oxygen saturation in all the cardiac chambers and vessels. The severity of haemodynamic impairment will then have to be defined. As well as the usual clinical criteria (blood pressure, diuresis), the trend in the capnographic curve during a reduction of extracorporeal blood flow rate and acid-base measurements are most helpful. If no further immediate surgery is found to be necessary, the most serious cases are treated by cardiopulmonary support (right to left, or cardiac left to left, or exceptionally biventricular), usually for 1 to 3 h.(ABSTRACT TRUNCATED AT 250 WORDS)
Durandy
Y
Y
Service de Chirurgie Cardiovasculaire, Centre Médico-Chirurgical de la Porte de Choisy, Paris.
Batisse
A
A
Bourel
P
P
Lecompte
Y
Y
D006328:Cardiac Catheterization; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004280:Dobutamine / Q000627:therapeutic use; D004452:Echocardiography; D006330:Heart Defects, Congenital / Q000188:drug therapy / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007511:Ischemia / Q000503:physiopathology; D007545:Isoproterenol / Q000627:therapeutic use; D011184:Postoperative Period
D002316:Cardiotonic Agents; D004280:Dobutamine; D007545:Isoproterenol
Traitement inotrope postopératoire dans la chirurgie cardiaque du nouveau-né et du nourrisson.