Wilhelm Alexander Osthaus

Hydroxyethyl starch 130/0.42/6:1 for perioperative plasma volume replacement in 1130 children: results of an European prospective multicenter observational postauthorization safety study (PASS).

Background:  Several clinical studies have shown that hydroxyethyl starch (HES) may be as effective and safe as, but less expensive than, albumin when used for perioperative plasma volume replacement (PVR) in children. The new third generation HES 130/0.42 solution was designed to reduce adverse drug reactions (ADRs) and improve safety while maintaining efficacy. Therefore, the objective of this prospective multicenter observational postauthorization safety study (PASS) was to evaluate the perioperative use of HES 130/0.42 in 1000 children with a particular focus on possible ADRs.

Comparison of electrical velocimetry and transpulmonary thermodilution for measuring cardiac output in piglets

Background:  Monitoring of cardiovascular function is essential during major pediatric and pediatric cardiac surgery. Invasive monitoring of cardiac output (CO) and oxygen delivery is expensive and sometimes associated with adverse events. Therefore, we investigated the accuracy of a new noninvasive CO monitoring device using electrical velocimetry (EV) in comparison with the more invasive transpulmonary thermodilution (TPTD) method.

Whole blood coagulation measured by modified thrombelastography (ROTEM) is impaired in infants with congenital heart diseases

Patients with congenital heart disease (CHD) often do have a variety of coagulation abnormalities that results in bleeding diathesis. Our study aimed to determine the impact of cyanosis and CHD on modified thrombelastography parameters, compared with children without CHD. Preoperative blood samples were taken for TEM analyses from a total of 51 infants scheduled for surgery. The following groups were examined: normal patients without CHD, acyanotic patients with acyanotic CHD, and cyanotic patients with CHD and with preoperative hemoglobin values higher than 15 g dl−1. Mean values of all patient groups as well as all individual values of normal patients were within their normal ranges. Within these limits, however, clots were significantly inferior in cyanotic patients (worse mean values of eight out of 10 measured TEM parameters representing the intrinsic, extrinsic, and plasmatic pathways of coagulation) and in acyanotic patients (two out of 10 TEM parameters). Individually, pathological TEM parameters were found in seven (41%) cyanotic patients (P = 0.003; vs. normal patients) and in three (17%) acyanotic patients (P = 0.01). More than one abnormal TEM coagulation parameter was found in four patients, all of them cyanotic patients. Hyperfibrinolysis was detected in one patient, a cyanotic patient. The present investigation confirms previous findings that in patients with CHD the heart defect itself compromises coagulation monitored with TEM, but in addition, we demonstrate that cyanosis and/or polycythemia exert the essential negative impact on hemostasis. Preoperative hyperfibrinolysis detected with TEM seems to play no important role.

A novel isotonic balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in neonates: results of a prospective multicentre observational postauthorisation safety study (PASS)

Background:  Neonates have a higher metabolic rate and an increased risk of perioperative hypoglycemia and lipolysis, but during anesthesia, both oxygen consumption and metabolic rate are decreased, and this may lead to reduced intraoperative glucose requirements.

A novel isotonic-balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in children: results of a prospective multicentre observational post-authorization safety study (PASS): A NOVEL ISOTONIC BALANCED ELECTROLYTE SOLUTION WITH 1% GLUCOSE

Background:  The recommendations for intraoperative fluid therapy in children have been adapted from hypotonic to isotonic electrolyte solutions with lower glucose concentrations (1–2.5% instead of 5%) to avoid hyponatremia and hyperglycemia.

Correlation of oxygen delivery with central venous oxygen saturation, mean arterial pressure and heart rate in piglets

Background:  Accurate assessment and monitoring of the cardiocirculatory function is essential during major pediatric and pediatric cardiac surgery. Invasive monitoring of cardiac output and oxygen delivery (DO2) is expensive and sometimes associated with adverse events. Measurement of central venous oxygen saturation (ScvO2) is less invasive and may reflect the DO2. Therefore, we investigated the correlation of ScvO2 with cardiac index (CI) and DO2 and in comparison the more common monitored parameters heart rate (HR) and mean arterial pressure (MAP) with DO2 in an animal experimental setting.

Hydroxyethyl starch 130/0.42/6:1 for perioperative plasma volume replacement in 1130 children: results of an European prospective multicenter observational postauthorization safety study (PASS): HES 130 for plasma replacement in children

Introduction:  Third‐generation hydroxyethyl starch (HES) is now approved also for the use in children, but safety studies including large numbers of pediatric patients are still missing. Therefore, we performed an European multicentric prospective observational postauthorization safety study (PASS) to evaluate the use of HES 130/0.42/6:1 in normal saline (ns‐HES) or a balanced electrolyte solution (bal‐HES) in children undergoing surgery.

The pediatric cardiac patient presenting for noncardiac surgery.

Purpose of review To summarize results of recent papers and discuss current trends concerning anesthesia in children with congenital heart disease presenting for noncardiac surgery. Recent findings Children with congenital heart disease have a significant incremental risk when presenting for minor or major surgery. It is a current trend that noncardiac surgery should be performed in pediatric centers, which have anesthesiologists and pediatricians familiar with the multiple specialties of children with congenital heart disease. A careful preoperative evaluation using a multidisciplinary approach is of great importance. In recent studies and case reports, the safe use of newer anesthetic agents, such as sevoflurane or desflurane, was reported in combination with opioids or regional blocks. In addition to standard monitors, invasive monitoring should be considered liberally perioperatively in patients with limited hemodynamic reserve and with major surgery. Several case reports reported that laparoscopic surgery was successfully performed even in high-risk patients with congenital heart disease. Summary Careful preoperative evaluation, experienced anesthesiologists, suitable anesthetic agents and techniques, and the liberal use of invasive monitoring are integral parts of safe and effective anesthetic care in children with congenital heart disease. Future studies have to show whether laparoscopic surgery may be beneficial in this special subgroup of patients.

Hemodynamic changes during acute elevation of intra-abdominal pressure in rabbits

Background:  The intra‐abdominal pressure (IAP) may be increased during pneumoperitoneum for minimally invasive surgery, after high tension repairs of congenital abdominal wall defects, major abdominal surgery, liver transplantation, abdominal trauma, peritonitis or ileus. The aim of this study was to investigate hemodynamic changes during elevation of IAP using an experimental setting, which mirrors anatomical and physiological conditions of neonates and small infants as closely as possible.

Changes in acid-base, electrolyte and hemoglobin concentrations during infusion of hydroxyethyl starch 130/0.42/6 : 1 in normal saline or in balanced electrolyte solution in children

Introduction:  A balanced volume replacement strategy is a well established concept for correcting hypovolemia using plasma adapted isotonic crystalloid solutions with a physiological electrolyte pattern and acetate as bicarbonate precursor. Recently, third‐generation hydroxyethyl starch (HES) has also become available in a balanced electrolyte solution instead of normal saline. Therefore, in this prospective non‐interventional clinical study, the perioperative administration of HES 130/0.42/6 : 1 in normal saline (ns‐HES) and in balanced electrolyte solution (bal‐HES) was evaluated in children with a focus on acid‐base, electrolyte and hemoglobin changes.