[Use of aprotinin during pediatric heart surgery].
OBJECTIVE
To study the efficacy of high doses of aprotinin during cardiopulmonary bypass (CPBP) in pediatric patients with a tendency to intra- and postoperative bleeding: children undergoing repeated operations and those with cyanotic cardiopathy.


METHODS
A simple retrospective, random sample of 71 pediatric patients with cyanogenic cardiopathy was studied. Group I (n = 36) received a test dose of 50,000 KIU in 2 min. The initial dose was 1,700,000 KIU (170 ml/m2 of body surface) i.v., at an infusion rate of 150 ml/h. CPBP circuit prime dose was 1,700,000 (170 ml/m2 of body surface), with replacement at a volume equivalent to the circuit prime. The maintenance dose was 400,000 KIU (40 ml/m2/h) i.v. Infusion was suspended 2 hours after a patient's arrival at the intensive care unit (ICU). We recorded red blood cell loss and blood product requirements in the first 24 hours in the ICU, duration of surgery, intra- and postoperative diuresis, and complications.


RESULTS
Group I required 13.96 +/- 12.09 ml/kg/h of packed red cells whereas Group II required 22 +/- 16.22 ml/kg/h (p < 0.05). The volume lost was less in Group I than in Group II (0.77 +/- 0.48 ml/kg/h vs. 2.12 +/- 3.9 ml/kg/h; p < 0.05). The means for intra- and postoperative diuresis in the first 24 hours were not significantly different.


CONCLUSIONS
Aprotinin significantly reduces red blood cell loss and homologous blood transfusion requirements. No complications attributable to aprotinin were observed.
Martín Burcio
S
S
Servicio de Anestesiología y Reanimación. Hospital Ramón y Cajal. Madrid.
Valiño González
J
J
Domínguez
F
F
Díaz Balda
J
J
Martínez
M
M
Vellibre
D
D
D000925:Anticoagulants / Q000627:therapeutic use; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D004341:Drug Evaluation; D004363:Drug Utilization; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006474:Hemorrhagic Disorders / Q000453:epidemiology; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010949:Plasma; D011897:Random Allocation; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk
D000925:Anticoagulants; D006490:Hemostatics; D006493:Heparin; D007611:Aprotinin