Biodegradable stents are equivalent to metal stents

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Fenaldopam

Journal List > BMC Anesthesiol > v.8; 2008		Formats: Abstract  |  Full Text  |  PDF (230K)
	BMC Anesthesiol. 2008; 8: 6. Published online 2008 October 6. doi:  10.1186/1471-2253-8-6 PMCID: PMC2576052 Copyright © 2008 Hammer et al; licensee BioMed Central Ltd. Pharmacokinetics and pharmacodynamics of fenoldopam mesylate for blood pressure control in pediatric patients Gregory B Hammer,1 Susan T Verghese,2 David R Drover,3 Myron Yaster,4 and Joseph R Tobin5 1Departments of Anesthesia and Pediatrics, Stanford University School of Medicine, Stanford, USA 2Departments of Anesthesia and Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, USA 3Department of Anesthesia, Stanford University School of Medicine, Stanford, USA 4Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, Johns Hopkins University, Baltimore, USA 5Departments of Anesthesiology and Pediatrics, Wake Forest University School of Medicine, Winston-Salem, USA Corresponding author. Gregory B Hammer: ham@stanford.edu; Susan T Verghese: sverghes@cnmc.org; David R Drover:ddrover@stanford.edu; Myron Yaster: myaster@jhmi.edu; Joseph R Tobin: jtobin@wfubmc.edu Received April 7, 2008; Accepted October 6, 2008. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  Other Sections▼ Abstract Background Fenoldopam mesylate, a selective dopamine1-receptor agonist, is used by intravenous infusion to treat hypertension in adults. Fenoldopam is not approved by the FDA for use in children; reports describing its use in pediatrics are limited. In a multi-institutional, placebo controlled, double-blind, multi-dose trial we determined the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics and side-effect profile of fenoldopam in children. Methods Seventy seven (77) children from 3 weeks to 12 years of age scheduled for surgery in which deliberate hypotension would be induced were enrolled. Patients were randomly assigned to one of five, blinded treatment groups (placebo or fenoldopam 0.05, 0.2, 0.8, or 3.2 mcg/kg/min iv) for a 30-minute interval after stabilization of anesthesia and placement of vascular catheters. Following the 30-minute blinded interval, investigators adjusted the fenoldopam dose to achieve a target mean arterial pressure in the open-label period until deliberate hypotension was no longer indicated (e.g., muscle-layer closure). Mean arterial pressure and heart rate were continuously monitored and were the primary endpoints. Results Seventy-six children completed the trial. Fenoldopam at doses of 0.8 and 3.2 mcg/kg/min significantly reduced blood pressure (p < 0.05) during the blinded interval, and doses of 1.0–1.2 mcg/kg/min resulted in continued control of blood pressure during the open-label interval. Doses greater than 1.2 mcg/kg/min during the open-label period resulted in increasing heart rate without additional reduction in blood pressure. Fenoldopam was well-tolerated; side effects occurred in a minority of patients. The PK/PD relationship of fenoldopam in children was determined. Conclusion Fenoldopam is a rapid-acting, effective agent for intravenous control of blood pressure in children. The effective dose range is significantly higher in children undergoing anesthesia and surgery (0.8–1.2 mcg/kg/min) than as labeled for adults (0.05–0.3 mcg/kg/min). The PK and side-effect profiles for children and adults are similar

Chest Pain Assessment in Children

SCAMP - Standardized Clinical Assessment Management Plan

JAHA April 2012

Demographic variables, clinical characteristics, and cardiac testing in a historical cohort (n=406) of patients presenting to our outpatient division for initial evaluation of chest pain in the most recent pre-SCAMP calendar year (2009) to patients enrolled in the chest pain SCAMP (n=364).

Demographic variables including age at presentation, sex, and clinical characteristics were similar between groups.

Adherence to the SCAMP algorithm for echocardiography was 84%. Practice variation decreased significantly after implementation of the SCAMP (P<0.001).

The number of exercise stress tests obtained was significantly lower in the SCAMP-enrolled patients compared with the historic cohort (∼3% of patients versus 29%, respectively; P<0.001).

Similarly, there was a 66% decrease in utilization of Holter monitors and 75% decrease in the use of long-term event monitors after implementation of the chest pain SCAMP (P=0.003 and P<0.001, respectively).

The number of echocardiograms obtained was similar between groups.

Conclusions Implementation of a SCAMP for evaluation of pediatric chest pain has lead to a decrease in practice variation and resource utilization.

Fundoplication & Gastrostomy ...outcome of single ventricle

Keating JJ et al.

JTCVS 2012;143:891-895

1999=2007

n=155

32 (21%) had fundoplication &/or G-tube (24 had both. 7 had G-tube only).

65 (42%) were HLHS. 24 of 65 had Fundos &/or G-tube.

Need for fundo &/or Gtube was associated with lower transplant-free survival.

CLOSURE trial result (PFO closure for Stroke)

Closure or Medical Therapy for Cryptogenic Stroke with Patent Foramen Ovale

Anthony J. Furlan et al.

NEJM 2012;366:991-9

Results:
A total of 909 patients were enrolled in the trial. The cumulative incidence (Kaplan–Meier estimate) of the primary end point was 5.5% in the closure group (447 patients) as compared with 6.8% in the medical-therapy group (462 patients) (adjusted hazard ratio, 0.78; 95% confidence interval, 0.45 to 1.35; P=0.37). The respective rates were 2.9% and 3.1% for stroke (P=0.79) and 3.1% and 4.1% for TIA (P=0.44). No deaths occurred by 30 days in either group, and there were no deaths from neurologic causes during the 2-year follow-up period. A cause other than paradoxical embolism was usually apparent in patients with recurrent neurologic events.

Conclusions:
In patients with cryptogenic stroke or TIA who had a patent foramen ovale, closure with a device did not offer a greater benefit than medical therapy alone for the prevention of recurrent stroke or TIA. (Funded by NMT Medical).

Procedures: Pericardiocentesis

Emergency pericardiocentesis video from NEJM 2012;366:e17

Realtime 3D in Congenital Heart Disease

Echocardiography 2012;29:232-41

Real time three-dimensional echocardiography (RT3DE) has been increasingly used in the diagnosis and assessment of congenital heart disease. A growing body of literature suggests that this new technology can be used as an integrated approach to assess the morphology of simple and complex congenital heart defects, flow abnormality, and left, right, and single ventricular function both qualitatively and quantitatively. This review summarizes the available evidence for the use of RT3DE in each of these areas. Future technology refinement in RT3DE and development of practice guidelines will increase the utilization of this new technology as a valuable tool to compliment 2D echocardiography/Doppler in clinical care and research to improve the care and outcome of congenital heart disease. (Echocardiography 2012;29:232-241)