Odegard Kirsten C, Schure Annette, Saiki Yoshikatsu, Hansen Dolly D, Jonas Richard A, Laussen Peter C
Department of Anesthesia, Children's Hospital, Boston, MA 02115, USA.
J Cardiothorac Vasc Anesth. 2004 Apr;18(2):144-7. doi: 10.1053/j.jvca.2004.01.017.
Caval inflow occlusion (IO) was introduced to facilitate surgical pulmonary and aortic valvotomy without cardiopulmonary bypass (CPB). Although a technique that is used infrequently today, it remains useful in some patients with complex single-ventricle congenital cardiac defects who require an atrial septectomy. The potential for complications and anesthetic considerations have not been described previously.
Retrospective review.
A tertiary care university teaching children's hospital.
Eleven children, median age 3 months (range 3 days-3 years) who underwent (IO) technique for atrial septectomy.
Atrial septectomy under IO in patients with restrictive atrial septum.
Eleven children, median age 3 months (range 3 days-3 years), underwent IO for atrial septectomy. Mean duration of IO was 87.7 +/- 25.5 seconds. There was 1 intraoperative death (9%). After release of the caval clamps, inotropic support was necessary in 7 of 11 patients, arrhythmias occurred in 4 of 11 patients (2 atrial and 2 ventricular fibrillation), and 10 of 11 patients required blood transfusion along with boluses of calcium gluconate and sodium bicarbonate to support the circulation immediately post-IO. Duration of postoperative mechanical ventilation was 2.2 +/- 1.6 days; 10 of 11 patients (91%) survived to discharge with mean length of intensive care unit stay 3.7 +/- 2.2 days.
IO is an effective technique for short intracardiac procedures without the need for CPB. Close collaboration between anesthesia and surgical staff is essential to keep the duration of IO as short as possible and because of the potential for hemodynamic instability.
腔静脉入流阻断术（IO）被用于在非体外循环（CPB）下实施外科肺动脉瓣和主动脉瓣切开术。尽管如今该技术使用频率不高，但对于一些需要进行房间隔切除术的复杂单心室先天性心脏缺陷患者仍有用处。此前尚未描述过其并发症发生可能性及麻醉相关注意事项。
回顾性研究。
一所三级医疗大学教学儿童医院。
11名儿童，中位年龄3个月（范围3天至3岁），接受了用于房间隔切除术的IO技术。
对限制性房间隔患者在IO下进行房间隔切除术。
11名儿童，中位年龄3个月（范围3天至3岁），接受IO进行房间隔切除术。IO的平均持续时间为87.7±25.5秒。有1例术中死亡（9%）。腔静脉钳松开后，11例患者中有7例需要使用正性肌力药物支持，11例患者中有4例发生心律失常（2例房性和2例室性颤动），11例患者中有10例在IO后需要立即输血并静脉推注葡萄糖酸钙和碳酸氢钠以维持循环。术后机械通气时间为2.2±1.6天；11例患者中有10例（91%）存活至出院，重症监护病房平均住院时间为3.7±2.2天。
IO是一种无需CPB即可进行短时间心内手术的有效技术。麻醉和手术人员密切协作对于尽可能缩短IO持续时间以及鉴于血流动力学不稳定的可能性至关重要。
