CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
5
SURGERY, ANAESTHESIA AND INTENSIVE CARE
the etomidate group at the end of surgery and 24 hours postopera-
tively were significantly lower than in the ketamine group.
Conclusion:
This study shows that etomidate is a suitable and safe
agent for suppression of the increase in serum cortisol associated
with the use of CPB in children with TOF undergoing intra-cardiac
repair.
16: POST-OPERATIVE ICU COURSE OF INFANTS BELOW
2.2 KG UNDERGOING CARDIAC SURGERY
Akhter Mehmood, Sameh Ismail, Mohamed Kabbani, Riyadh
Abu-sulaiman, Hani Najm
King AbdulAziz Cardiac Centre, King AbdulAziz Medical City,
Riyadh, Saudi Arabia
Introduction:
Infants with low body weight (LBW) are major
challenges for postcardiac surgery care. We conducted this study to
compare postoperative course and outcome of infants weighing 2.2
kg or less with a matching group of infants with normal body weight
who underwent similar cardiac surgery.
Methods:
We retrospectively reviewed all infants below 2.2 kg who
underwent cardiac operations at our institution from January 2001
to March 2011. Cases with LBW (group A) were compared with
the matching group (group B) of normal body-weight infants who
had similar cardiac surgery and matching surgical risk category. We
compared demographics, ICU parameters, complications and short-
term outcome of both groups.
Results:
Thirty-seven patients were included in group A and 39 in
group B. Except for weight (2.13
±
0.08 kg in group A vs 3.17
±
0.2
kg in group B), there was no statistical difference in demographic
data between the groups. Cardiac procedures included coarctation
repair, arterial switch, VSD repair, tetralogy of Fallot repair, system-
ic-to-pulmonary shunt and Norwood procedures. Patients in group
A had a statistically significant difference from group B in terms of
bypass time (
p
=
0.01), duration of inotrops (
p
=
0.01), duration of
mechanical ventilation (
p
=
0.004), number of re-intubations (
p
=
0.015), PCICU length of stay (
p
=
0.007) and mortality (13.5% in
group A vs 0% in group B,
p
=
0.02).
Conclusion:
Patients with LBW below 2.2 kg can go for cardiac
surgery with overall satisfactory results but with increased risk of
ICU morbidity and mortality.
37: S-100B PROTEIN AND PERI-OPERATIVE BRAIN INJU-
RY IN CONGENITAL HEART DISEASE INFANTS AND
CHILDREN UNDERGOING OPEN-HEART SURGERY
USING CARDIOPULMONARY BYPASS
Omneya IbrahimYoussef, Nevin Mamdouh Habeeb, Adel Al Ansary,
Nermeen Helmy, Nadine Mamdouh Habeeb
Faculty of Medicine, Ain Shams University, Cairo, Egypt
Brain-derived S-100B protein has been shown to be a useful marker
of brain injury. Neurodevelopmental problems in patients with
congenital heart diseases (CHD) have become the focus of increas-
ing concern.
Aim
: To assess level of S-100B protein as a brain-damage marker in
patients with CHD undergoing cardiosurgical procedures involving
cardiopulmonary bypass (CPB) both pre- and postoperatively.
Methods
: Fifteen patients (eight with cyanotic and seven with
acyanotic heart disease) with a mean age of 4.8
±
3.9 years, who
were neurologically free of brain damage and had been admitted to
the cardiosurgery department for procedures involving CPB, were
enrolled in the study. They were compared to 15 healthy children as
a control group. S-100B protein levels as well as heart rate, mean
arterial blood pressure, haematocrit value, central venous pressure
(CVP), PO
2
and PCO
2
were assessed before surgery, half an hour
after CPB and 24 hours after surgery.
Results
: S-100B protein levels were significantly elevated in patients
8: SYNERGIES IN OPEN-HEART SURGERY IN ZAMBIA IN
2011
John Musuku
1
, Bruce Bvulani
1
, Emmanuel Makasa
1
, Munanga
Mwandila
2
, Harsh Singh
2
,WilsonMbewe
1
, SlavetilanaKalininchecho
1
,
Dorothy Kavindele1, Evans Mulendele
1
, Christopher Kangwa
3
1
University Teaching Hospital, Lusaka, Zambia
2
Christchurch, New Zealand
3
Cardiac Trust of Zambia, Zambia
Background:
Currently, heart operations are not done in Zambia
due to lack of infrastructure, equipment and skilled manpower. Most
patients have heart operations abroad at very high costs. Even if the
government sends patients abroad for these heart surgeries, it cannot
afford the prohibitive costs for every needy Zambian. Although the
Ministry of Health through the University Teaching Hospital
ad
hoc
committee has the responsibility of ensuring that patients needing
specialised treatment are given the opportunity either locally or
abroad, there is a long and growing waiting list of patients needing
cardiac surgery. Unfortunately most patient on the waiting list die
before their turn for specialised heart surgery.
Objectives
: To present the results of open-heart surgeries done in
Zambia by the Mutima project.
Methods:
Fifteen patients were selected for surgery after meeting the
criteria; seven were operated on. Five patients had rheumatic heart
disease (RHD), one had a PDA and another had an atrial myxoma.
The median age group for the patients was 29 years and all were
female.
Results:
Seven female patients with age range of 14 to 43 years were
successfully operated on with good results. Five patients had valve
replacement for RHD, one had left atrial myoma excision and one
a PDA ligation. Three patients received tissue valves and two had
mechanical valves.
Conclusion:
Visiting teams are a short-term solution but are not
sustainable. They do help to clear the patient backlog on the waiting
list and stimulate interest in local personnel through transfer of skills
in cardiovascular medicine and surgery.
10: THE VARIATION IN PLASMA CORTISOL LEVELS IN
RESPONSE TO ANAESTHETIC INDUCTIONWITH ETOMI-
DATE OR KETAMINE IN CHILDREN UNDERGOING
INTRA-CARDIAC REPAIR OF TETRALOGY OF FALLOT
Sandeep Chauhan, Anil Pandey, Sachin Talwar, R Lakshmi
All India Institute of Medical Sciences, New Delhi, India
Objective:
To compare the effect of a single induction dose of etomi-
date or ketamine on plasma cortisol levels in children with tetralogy
of Fallot (TOF) undergoing intra-cardiac repair on cardiopulmonary
bypass (CPB).
Methods
: This was a prospective, randomised trial performed at
a tertiary-care hospital on 30 children with TOF undergoing intra-
cardiac repair on CPB. After random allocation of the children to two
groups, they received either etomidate or ketamine 0.2 mg/kg intra-
venously for anesthetic induction, along with fentanyl 2 mcg/kg and
midazolam 100 mcg/kg. Anaesthesia was maintained with sevoflu-
rane in air:oxygen. Serum cortisol was measured on three occasions:
pre-operatively, at the end of surgery and 24 hours postoperatively.
Results:
The two groups were comparable with regard to age: 18.86
±
3.81 months in the etomidate group versus 17.93
±
4.68 months in
the ketamine group; bypass times: 60.87
±
6.20 min in the etomidate
versus 64.35
±
5.06 min in the ketamine group. Baseline plasma
cortisol (normal 5–25 mcg/dl) in the etomidate group (19.91
±
3.51
mcg/dl) decreased significantly at the end of surgery (5.78
±
2.0 mcg/
dl) and rose to significantly higher than baseline values at 24 hours
(27.31
±
8.30 mcg/dl). The baseline cortisol levels in the ketamine
group (20.91
±
3.19 mcg/dl) increased significantly at the end of
surgery (44.02
±
5.49 mcg/dl) and remained significantly higher than
baseline at 24 hours (45.93
±
3.05 mcg/dl). Plasma cortisol levels in
