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• W2888880979 abstract "INTRODUCTION:The children undergoing open-heart surgery are likely to havemajor blood loss due to surgical interventions performing on majorvascular structures as well as the coagulation abnormalities thataccompany extracorporeal techniques. Certain characteristics are uniqueto paediatric patients with congenital heart disease undergoing heartsurgery, that makes them prone to excessive bleeding and transfusion ofblood and blood products. They are:• Decreased levels of coagulation factors compared with normal children of the same age group.• Hemodilution resulting from high priming volume relative to small blood volume.• Delayed hepatic maturation secondary to poor organ perfusion.• Complex operative procedures requiring long duration of cardiopulmonary bypass.• Multiple extra cardiac suture lines.• Deep hypothermic circulatory arrest.The use of aprotinin in children undergoing cardiopulmonary bypassattenuates the activation of the coagulation and fibrinolytic systems, preservesplatelets function and reduces systemic inflammatory responses. Improvedclinical outcomes have been consistently demonstrated in children undergoingprimary and repeat sternotomies in aprotinin recipients. Many studies havedemonstrated benefits in terms of;• Significant reduction in chest tube drainage,• Time to skin closure,• Postoperative transfusion requirements,• Decreased requirements of banked blood and donor,Exposures,• Substantial savings in cost.These clinical outcomes create a strong argument for the routineadministration of aprotinin in paediatric cardiac operations undergoingcardiopulmonary bypass. Aprotinin is a potent part of an anesthesiologistarsenal when dealing with children undergoing cardiopulmonary bypass and itscost effective improvement of clinical outcomes justifies its considerationwhen planning the management strategy of these children.AIM OF THE STUDY:The purpose of the study was to assess the efficacy and use ofaprotinin in paediatric open heart surgeries by comparing the timeinterval from protamine administration to skin closure, the volume ofblood loss (ml/kg) in chest drain after 24 hours, and the volume of bloodand blood products (ml/kg) transfused postoperatively with that ofcontrol group.MATERIALS AND METHODS:Study Design:This study was conducted in Paediatric Cardiothoracic Departmentat Institute of Child Health, an attached institution of Madras MedicalCollege, Chennai between June 2008 and August 2008 on forty patients,posted for elective major cardiac surgery. This study was done afterinstitutional approval and written informed consent was obtained fromthe parents of each child included in the study.This study was done in a prospective randomized manner. Fortypatients of either sex posted for major elective cardiac surgeriessatisfying the selection criteria were randomly allocated into the twogroups (Group A and Group P)Group (A) - Patients in this group received aprotinin 20000 KIU/kgbolus after induction, 20000 KIU/kg in prime andmaintenance infusion dose of 10000 KIU/kg/min tillskin closure.Group (P) - Patients in this group received equal volume protocol of Ringer Lactate solution.SELECTION OF CASES:Inclusion criteriaChild under any age of less than 12 years undergoing open heartsurgery using cardiopulmonary bypass (CPB) is considered eligible forentry into the study.Exclusion criteria:• Patient refusal• Patients with known bleeding disorder; those taking aspirin,dipyridamole,or anticoagulants 7 days before surgery.•Patients with a known metabolic disorder, sepsis, or renalfailure• Patients previously exposed to aprotinin or with a knownallergy to aprotinin• Patients with a hemoglobin level of more than 19 g/dl.Preanaesthetic evaluationSUMMARY:In this study the efficacy and use of aprotinin in paediatric cardiacsurgery was assessed based on following parameters:1. The time interval (min) from protamine administration to skinclosure.2. The volume of blood loss (ml/kg) in chest drain after 24 hours.3. The volume of blood and blood products (ml/kg) transfusedpostoperatively.1. The mean time interval (min) from protamine administration to skinclosure in Group A - 31.45 +/- 6.08 min, Group P - 52.05 +/- 8.71 min.There is significant reduction in duration of time from protamineadministration to skin closure in group A.2. The mean volume of blood loss (ml/kg) in chest drain after 24 hours inGroup A- 7.01 +/- 3.13 ml/kg, Group P – 8.72 +/- 3.09 ml/kg.There is no significant reduction in volume of blood loss in chestdrain in Group A.3. The mean volume of blood and blood products (ml/kg) transfused postoperatively in Group A - 8.36 +/- 5.49 ml/kg, Group P - 11.76 +/- 4.62 ml/kg.There is significant reduction in volume of blood and blood products transfused postoperatively in Group A.CONCLUSION:From this study, it is observed that in children undergoing open heart surgery using cardiopulmonary bypass, aprotinin is effective in improving clinical outcomes of the patients, by reducing postoperative blood transfusion requirements and duration of the surgery. There is a decreased requirement of banked blood and donor exposures. Aprotinin recipients have a significantly dry operative field after protamine reversal, aiding in early hemostasis and skin closure, thereby it shortens the duration of surgical procedure. Hence it is concluded that aprotinin is useful in anaesthetic management of the children undergoing open heart surgery." @default.
• W2888880979 created "2018-09-07" @default.
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• W2888880979 date "2009-03-01" @default.
• W2888880979 modified "2023-09-24" @default.
• W2888880979 title "Role of Aprotinin in Paediatric Cardiac Surgery" @default.
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