The postoperative management for systemic-pulmonary shunt surgery
Egoh, Y.; Tanaka, K.; Kumon, K.; Naito, Y.; Fujita, T.; Manabe, H.
Nihon Kyobu Geka Gakkai 30(9): 1514-1519
1982
ISSN/ISBN: 0369-4739 PMID: 7153575 Document Number: 189031
A clinical study was conducted on 68 patients who had received systemic-pulmonary shunt surgery. Arterial blood gas saturation at the time of extubation was approximately 80%. The majority of patients could be extubated before the 2nd postoperative day. Prolonged intubation was necessitated in 6 patients by the presence of atelectasis or cardiac failure due to excess high flow in shunt. When patients manifested with clinical symptoms of bradycardia and metabolic acidosis with arterial CO2 pressure over 60 mm Hg, frequent tracheal suction and administration of a bronchodilator were needed. Creation of central shunt with a graft between the ascending aorta and the pulmonary artery tended to produce high flow in the shunt which caused the development of cardiac failure, a prolonged intubation period and frequent administrations of catecholamines. Isoproterenol was selected as the 1st choice but epinephrine was used in certain occasions. In this situation, metabolic acidosis due to the peripheral circulatory failure secondary to peripheral vascular constriction was noted but increase of pulmonary blood flow with elevation of PaO2 was also observed. This phenomenon, improvement of PaO2 and creation of peripheral circulatory failure was named the seesaw phenomenon. In this particular situation, concomitant administration of vasodilator was quite efficient.