Introduction: Early extubation after cardiac operations is an important aspect of fast-track cardiac anesthesia. In order to reduce or eliminate the adverse effects of prolonged ventilation, the concept of early extubation in pediatric patients has been examined at our institution. Material and methods: To allow rapid emergence from anesthesia post cardiac surgery, low-dose opioids, supplemented with continuous propofol infusion and low concentration of inhaled agent was used. Intercostal nerve block was used in thoracotomy operations. Contraindications to early extubation were: cardiopulmonary bypass (CPB) > 2.5 hours, hemodynamic instability, uncontrolled bleeding, severe pulmonary hypertension and congestive heart failure. Results: Eighty-two consecutive patients were reviewed. The age range was 6 months - 14 years with mean of 3.3 years. Closed cardiac procedures were performed in 15 (18.3%) patients, and operations with Cardio-pulmonary bypass in 67 (81.7%) patients. No patient required re-intubation during the first 24 hours after operation. One patient was re-intubated 48 hours after extubation for sputum retention. There was no mortality, and the incidence of perioperative morbidity was low. Conclusion: Early extubation after pediatric cardiothoracic operations can be achieved safely, and is possible in the majority of such patients.

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Background: Systolic and diastolic function is impaired in patients with hypertensive heart disease. Systolic hypertension induces a succession of LV hemodynamic changes and can be regarded as a spectrum from maladaptive hypertophy to heart failure. The left ventricular hemdynamic changes that occur can be measured non-invasively by Doppler echocardiography. Objective: The aim of the study was to hemodynamically characterize the different phases of left ventricular (LV) function in patients affected by systemic hypertension (SH). Method: 95 normotensive healthy controls (group I) and 94 hypertensives (group II) were enrolled. Hypertensive patients were divided in two sub-groups according to echocardiographic signs of left ventricular hypertrophy (LVH). Other echocardiographic parameters measured using tissue Doppler were Isovolumic Relaxation Time (IRT), isovolumic contraction time (ICT), and systolic motion (Sm). Myocardial Performance Index (MPI) using Tissue Doppler Echocardiography (TDE) was defined in both the control group and the two hypertensive subgroups. Ejection fraction (EF) was also calculated in all participants. Results: An increased MPI derived from the rise of isovolumetric relaxation time (IRT) was found in hypertensives without LVH (sub-group II-a), whereas isovolumetric contraction time (ICT) and Systolic motion (Sm) were unchanged. Hypertensive patients with LVH demonstrated more prominent increase of MPI, increase in IRT-prolongation, ICT-increase and Sm-decrease. The results obtained indicate impaired relaxation in sub-group II-a. On the contrary, a systolo-diastolic LV dysfunction was found in sub-group II-b. E.F decreased in this same sub-group of hypertensives in comparison with controls and sub-group II-a, as a sign of maladaptive LVH evolving towards heart failure. Conclusion: Doppler echocardiography appears able to distinguish the different forms and degrees of LV dysfunction in SH in relation to the different phases of the hypertensive disease process.

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Background: Elevated blood glucose values are a prognostic factor in myocardial infarction (MI) patients. The unfavorable relation between hyperglycemia and outcome is known for admission glucose and fasting glucose after admission. These predictors are single measurements and thus not indicative of overall hyperglycemia. Increased persistent hyperglycemia may better predict adverse events in MI patients. Methods: In a prospective study of MI patients treated with primary percutaneous coronary intervention (PCI) frequent blood glucose measurements were obtained to investigate the relation between glucose and the occurrence of major adverse cardiac events (MACE) at 30 days follow-up. MACE was defined as death, recurrent infarction, repeat primary coronary intervention, and left ventricular ejection fraction equal to or smaller than 30%. Results: MACE occurred in 89 (21.3%) out 417 patients. In 17 patients (4.1%) it was a fatal event. A mean of 7.4 glucose determinations were available per patient. Mean +/- SD admission glucose was 10.1 +/- 3.7 mmol/L in patients with a MACE versus 9.1 +/- 2.7 mmol/L in event-free patients (P = 0.0024). Mean glucose during the first two days after admission was 9.0 +/- 2.8 mmol/L in patients with MACE compared to 8.1 +/- 2.0 mmol/L in event free patients (P < 0.0001). The area under the receiver operator characteristic curve was 0.64 for persistent hyperglycemia and 0.59 for admission glucose. Persistent hyperglycemia emerged as a significant independent predictor (P < 0.001). Conclusion: Persistent hyperglycemia in MI has a stronger relation with 30-day MACE than elevated glucose at admission.

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