Arthroscopic-assisted Treatment of a Posterolateral Tibial Plateau Fracture with an Accompanying Tibial Eminence Fracture. Case Report.

Posterolateral tibial plateau fractures pose a challenge even to the most experienced orthopedic trauma specialists. Arthroscopic fracture management techniques have been emerging as an increasingly popular alternative in the treatment of selected tibial plateau fractures. This technique enables precise visualization of the articular surface of the tibia and its anatomical reduction with lateral meniscus repair, which further enables the restoration of biomechanical function of the meniscus and prevents early degeneration.

The Road to Transfusion-free Craniosynostosis Repair in Children Less Than 24 Months Old: A Quality Improvement Initiative.

Introduction: Pediatric craniofacial reconstruction has historically resulted in extensive blood loss necessitating transfusion. This single-center quality improvement initiative evaluates the impact of perioperative practice changes on the allogeneic transfusion rate for children 24 months and younger of age undergoing craniofacial reconstruction.

Methods: At project initiation, an appointed core group of anesthesiologists provided all intraoperative anesthetic care for patients undergoing craniofacial reconstruction.

Retrograde Autologous Priming Technique to Reduce Hemodilution during Cardiopulmonary Bypass in the Pediatric Cardiac Patient.

Blood conservation techniques during pediatric congenital heart surgery continue to be a vital strategy in reducing hemodilution during cardiopulmonary bypass. Development of mini circuits, retrograde autologous priming, modified ultrafiltration, and use of a cell saver are methods adopted by pediatric heart programs to limit transfusions. Excessive hemodilution may warrant the need for transfusion in the pediatric patient, which carries significant risks in the overall care of the patient.

Bloodless Repair of Aortic Arch with Dual Aortic Cannulation in a Jehovah's Witness Patient.

Various methods for surgical repair of the aortic arch are described throughout the literature with many focused on cannulation techniques and degree of systemic cooling in an effort to reduce postoperative morbidities. Despite advancements in techniques, this surgery is still often associated with higher levels of blood loss and subsequent allogenic blood transfusions. Although blood products can be safely transfused to the majority of patients undergoing repair of the aortic arch, the complexity and risk is further multiplied when the patient is of Jehovah's Witness faith and refuses blood transfusions.

Stage 1 palliation for hypoplastic left heart syndrome without the use of allogeneic tissue, with reduced allogeneic blood product exposure: a case report.

In the 30 years since Norwood described the palliative procedure for hypoplastic left heart syndrome (HLHS), many modifications have been described which have increased the survival rate of children born with this lesion. We describe further modifications which result in reduced cardiopulmonary bypass time, no cooling or circulatory arrest time, and decreased banked blood exposure. A 16-day-old infant with HLHS undiagnosed during pregnancy presented for stage 1 palliation incorporating the Mee modification, Sano right ventricle to pulmonary artery conduit, dual arterial cannulation of the innominate artery and descending aorta, single venous cannulation of the right atrium, and a bypass prime volume of 130 mL.

Clinical evaluation of the Terumo Capiox FX05 hollow fiber oxygenator with integrated arterial line filter.

Perfusion techniques and equipment in pediatric open heart surgery have continued to focus on decreasing prime volumes and lowering surface areas of the cardiopulmonary bypass circuit. While this has improved drastically over the last 20 years, greater demand is being placed on the perfusionist to reduce the deleterious effects of bypass without compromising safety or efficiency. Specifically, manufacturers of disposable perfusion equipment have focused on providing pediatric perfusionists with oxygenators that provide the smallest prime and surface area possible while attempting to maximize performance.

Cerebral oxygen saturation does not normalize until after stage 2 single ventricle palliation.

Background: In an effort to optimize neurologic outcome, cerebral oxygen saturation (SCO2) is often measured intraoperatively and postoperatively. We hypothesized that SCO2 would be related to stage of palliation in children with single ventricle congenital heart disease.

Methods: Cerebral oxygen saturation was continuously recorded intraoperatively in 34 infants and children undergoing palliative surgery on cardiopulmonary bypass for single ventricle congenital heart defects and in a control group of 12 neonates with ductus-dependent circulation undergoing complete repair.

Evaluation of biocompatible cardiopulmonary bypass circuit use during pediatric open heart surgery.

The contact of blood with nonbiological surfaces during cardiopulmonary bypass (CPB) induces a whole body inflammatory response and increases postoperative morbidity directly related to bleeding complications and end organ dysfunction. Methods to reduce these effects have included modification of extracorporeal circuits through biocompatible coating of disposables and the application of various pharmacological agents. Biocompatible coated surfaces are designed to mimic physiologic surfaces.

The significance of baseline cerebral oxygen saturation in children undergoing congenital heart surgery.

Objectives: Despite recent significant improvement in outcome, children undergoing surgery for correction of congenital heart defects have a persistent and troublesome mortality rate and incidence of neurologic complications. Recent data suggest that some congenital heart defects are associated with abnormal brain development and with low cerebral blood flow. We hypothesized that some children with congenital heart disease have an abnormally low baseline (preoperative) cerebral oxygen saturation (ScO2).

Extended support with the Terumo Baby-RX oxygenator.

The Terumo Baby-RX, a new-generation low prime oxygenator, recently has entered the perfusion market in North America. This oxygenator is designed exclusively for neonates and infants and has the smallest priming volume of any clinically available oxygenator. The BABY-RX also is treated with X Coating, Terumo's biocompatible, hydrophilic polymer surface coating that reduces platelet adhesion and protein denaturation.

A technique for performing antegrade selective cerebral perfusion without interruption of forward flow or cannula relocation for pediatric aortic arch reconstruction.

New technology and advances in extracorporeal bypass circuitry and surgical techniques have drastically improved outcomes in infants with congenital heart defects. Hypothermia with circulatory arrest has fallen out of favor in many institutions over the last decade in part from data implicating even short circulatory arrest times to long-term neurologic sequelae. Implementing continuous cerebral perfusion techniques for aortic arch reconstruction is desirable in ameliorating neurologic complications because long-term survival of complex defects can be more routinely achieved.

Conversion from extracorporeal membrane oxygenation to total cardiopulmonary bypass: a simplified method.

Pediatric patients who have preoperative hemodynamic instability or postoperative cardiac decompensation may frequently require the use of extracorporeal membrane oxygenation (ECMO) for stabilization of cardiac and respiratory function. While ECMO can be a therapeutic treatment for the congenital pediatric patient, it does not allow the additional functions of a complete cardiopulmonary bypass (CPB) circuit should subsequent surgical revision in the operating room be required. This paper will discuss our approach to converting the ECMO circuit to total cardiopulmonary bypass allowing the use of cardioplegia, cardiotomy suction, and modified ultrafiltration.

The effect of PaCO2 on cerebral perfusion: an experimental swine model.

Adequate cerebral perfusion is of particular concern to the clinician and is a major factor in postoperative morbidity. Cerebral circulation has the ability to autoregulate blood flow in order to maintain nutrient delivery and prevent high intravascular pressures. The focus of this study was to characterize the impact of gradually changing arterial CO2 levels on cerebral perfusion.

An in vitro study of the effects of isoflurane on oxygen transfer.

A common anesthetic technique utilized during cardiopulmonary bypass (CPB) includes the use of various inhalation agents, such as isoflurane. The purpose of this study was to evaluate the effects of this agent on oxygen transfer during CPB. An in vitro model was designed using bovine blood.

Effect of partial-filling autotransfusion bowls on the quality of reinfused product.

Intraoperative autotransfusion is used in a variety of surgical procedures with the quantity of blood loss dependent upon numerous factors. These procedures may or may not produce a full autotransfusion bowl. The inadequate removal of contaminants has been correlated to the incomplete filling of bowls, resulting in a condition called "Salvaged Blood Syndrome.

The effect of priming techniques of ultrafiltrators on blood rheology: an in vitro evaluation.

The increased interest of using ultrafiltration during cardiopulmonary bypass ICPB) has mandated a re-evaluation of the hematological effects of this blood conservation process. 'Rinse-free' ultrafiltrators can be primed using either crystalloid or blood prior to use. It is unknown whether one priming technique results in superior results in ultrafiltration quality.

An experimental evaluation of continuous cardiotomy reservoir ultrafiltration.

Ultrafiltration has been suggested as a means to reduce the morbidity associated with blood activation. However, the application of ultrafiltration to the highly activated blood of the cardiotomy suction subcircuit has not been investigated. The purpose of this study was to determine whether cardiotomy reservoir ultrafiltration (CRUF) would be effective in altering cytokine levels.

The effects of continuous blood gas monitoring during cardiopulmonary bypass: a prospective, randomized study--Part II.

The impact of blood gas management during cardiopulmonary bypass (CPB) on patient care has not been examined and remains controversial. The purpose of this study was to determine whether precise blood gas management during CPB influences patient outcome. Fifty-nine patients were enrolled in an Institutional Review Board-approved, prospective, randomized study.

Effect of surrogate tolerogenesis on the vascular rejection of pig heart xenografts.

Background: Organ xenografts are fulminantly rejected by antibody-mediated vascular rejection. Surrogate tolerogenesis (ST), the induction of tolerance within the donor, is effective with aorta xenografts. This preliminary study assesses the effect of ST on preformed antibodies and rejection of porcine heart xenografts.

[Latent iron-binding capacity of normal serum proteins by means of Fe-59].

Experimental investigations were carried out for confirming the possibility of saturation of the basic serum components with exogenous iron (not only transferin). In gel chromatography, paper electrophoresis and acetate cellulose electrophoresis it was demonstrated that the latent capacity for iron saturation is a feature of not only transferrin belonging to beta1 globulins, but also to some extent of albumins and alpha-globulins. Iron distribution was studied after 59Fe administration.