Gary Raff

Perioperative antibiotic prophylaxis in paediatric cardiac surgery

RISK OF INFECTION, AND ANTIBIOTIC PROPHYLAXIS, are topics that have been debated for decades by those involved in the care of children undergoing cardiac surgery. In this review we attempt to analyse what is known and what has been postulated about this subject. Suggestions regarding the best strategies for treatment have been formulated, based on published reports, as well as current practices worldwide.

Sternal plating to correct an unusual complication of the Nuss procedure: erosion of a pectus bar through the sternum.

We present erosion of a pectus bar through the sternum in a patient with Marfan syndrome. The complication as well as a novel technique for sternal reconstruction are reviewed.

Type B lactic acidosis and insulin-resistant hyperglycemia in an adolescent following cardiac surgery.

Objective: To report the presence of type B lactic acidosis and insulin-resistant hyperglycemia following cardiopulmonary bypass in a pediatric patient. Design: Case report. Setting: Tertiary referral children’s hospital pediatric intensive care unit. Patient: Fourteen-year-old child with hyperlactatemia and hyperglycemia following cardiac surgery. Interventions and Results: We report a patient who following cardiopulmonary bypass for repair of his congenital heart disease developed type B lactic acidosis and hyperglycemia resistant to insulin therapy. Resolution of his hyperlactatemia and hyperglycemia occurred approximately 24 hrs postoperatively without apparent ill effect. Conclusions: Type B lactic acidosis is a phenomenon that may occur in the pediatric population in conjunction with insulin-resistant hyperglycemia. We observed that its resolution corresponded to improvement in the patient’s hyperglycemia.