Comparison of Analgesic/Sedative Effect of Racemic Ketamine and S(+)-Ketamine during Cardiac Catheterization in Newborns and Children

The hypnotic and analgesic effect of ketamine with maintained spontaneous breathing is used for analgesic/sedative anesthesia without the need of intubation. The intention of this study was to compare the efficacy and side effects of racemic ketamine and its enantiomer S(+)-ketamine during cardiac catheterization in newborns and children. One hundred children (ages 0–11 years) were randomly assigned to groups of equal size. The differences between the racemic ketamine/midazolam and the S(+)-ketamine/midazolam groups were investigated regarding the total dosage of sedative drugs, side effects, and the awakening period. The dosage of S(+)-ketamine (2.28 mg/kg/h) was significantly lower than that needed for racemic ketamine (3.12 mg/kg/h) (p = 0.037) with an analgesic/sedative potency ratio of 1.4:1. Balloon dilatation required significantly higher dosages in both groups (p = 0.043). Significantly more patients were excluded because of ineffective analgesia/sedation or severe side effects in the racemic ketamine group. The awakening period did not show significant differences between the two groups. S(+)-ketamine proved to be a more efficient analgesic/sedative drug in newborns and children. It was shown to be useful in diagnostic and interventional procedures and allows spontaneous breathing. Moderate side effects occurred in both groups; severe side effects seemed to occur more often with the racemic solution.     

Retrograde Approach for Device Closure of Muscular Ventricular Septal Defects in Children and Adolescents, Using the Amplatzer Muscular Ventricular Septal Defect Occluder

This study presents technique and initial experience of retrograde deployment of the Amplatzer muscular ventricular septal defect occluder (AmVSDo) for closure of muscular ventricular septal defects (VSDs). The conventional technique for closing muscular VSDs involves the creation of an arteriovenous guidewire circuit and use of a transvenous approach for device deployment. Seven patients aged 2.2–15 years underwent transcatheter closure of a muscular VSD using the retrograde approach without making the arteriovenous wire circuit. Mean fluoroscopy and procedural times were compared to those previously reported in publications describing the use of the antegrade approach. Unpaired Student’s t-test was used to compare the two parameters in two groups. Our technique was successful in all patients reported. The mean fluoroscopy time in the retrograde versus the antegrade group was 33.8 ± 20.9 and 41.9 ± 6.2 minutes, respectively (not significant), and the mean procedural time in the two groups was 91.1 ± 22.1 and 114 ± 33.9 minutes respectively (p = 0.025). No complications were noted. We suggest that some muscular VSDs can be safely closed retrogradely without the use of an arteriovenous loop, thus reducing the radiation exposure and also the cost of the procedure. Further studies are needed to confirm this initial experience.     

血清心脏肌钙蛋白I在儿童川崎病中的诊断价值

目的：探讨静脉注射免疫球蛋白(IVIG)在川崎病(KD) 治疗前后血清心肌肌钙蛋白I(cTnI)浓度变化的临床意义。方法：检测 KD组 (n=58) 及对照组 (n=23) 患儿血清 cTnI、肌酸激酶(CK)、乳酸脱氢酶( LDH)与谷草转氨酶(GOT)的浓度。结果：KD组血清cTnI浓度为(0.62±1.08) μg/L,明显高于对照组(0.06±0.06) μg/L,两者差异有显著性意义(P0.05)。IVIG治疗后cTnI浓度为(0.08±0.15) μg/L,明显低于治疗前(0.62±1.08) μg/L,差异有显著性意义(P0.05)。结论：cTnI是一项早期诊断 KD患儿急性心肌损伤的有价值的方法,可为早期静脉注射免疫球蛋白减少心血管病变提供依据,并可作为 IVIG疗效观察指标。