264
! ETTERS TO THE EDliGP
Hoarseness following coronary artery bypass surgery is usually attributed to endotrachcal intubation. However. i 1I internal mammary artery dissection, (2) laryngeal edema, or (3) arytenoid cartilage dislocation can account for thtq complication. Any patient with hoarseness lasting for more than 5 days should have indirect laryngoscopy to rule out recurrent laryngeal nerve palsy.
Pieme A. Castheiy, MD Division of Cardiac Anesthesia St Joseph’s Hospital Center Paterson. NJ James Labagnaru, MD Department of Otorhinolaryngology UMDNJ Newark, NJ REFERENCES 1. Pepopard SB, Dickens JH: Laryngeal injury following short-term intubation. Ann Otol Rhino1 Latyngol Y2:317, 1983
2. Phillips T, Green G: Left recurrent laryngeal nerve injury following internal mammary artery bypass. Ann Thorac Surg 43:440, 1987 3. Prasertwanitch Y, Schwartz JJH, Vandam LD: Arytenoid cartilage dislocation following prolonged endotracheal intubation. Anesthesiology 41516, 1974
Continuous
Sedation
of Postoperative
Pediatric Propofol
Cardiac
Surgical
Patients
with
To the Editor: Propofol is a short-acting intravenous anesthetic agent that has been used for total intravenous anesthesia. Recently, long-term infusion of propofol has been introduced to sedate critically ill patients.” We have found only two case reports describing the use of propofol to sedate children4,’ Until now, we have administered propofol postoperatively as a continuous infusion to three pediatric cardiac surgical patients. All three children aged 6 months to 2.5 years had uncomplicated patch closures of ventricular septal defects. Intraoperatively, flunitrazepam and fentanyl were given as anesthetic agents. Postoperatively, controlled mechanical ventilation was continued for 7 to 11 hours. Propofol as a continuous infusion at a dose of 2 to 2.5 mg/kg/h was started on arrival in the intensive care unit. All routine laboratory parameters remained within normal levels. In each case, extubation of the trachea was possible within 10 to 20 minutes after stopping the propofol infusion. In our pediatric patients, propofol provided adequate sedation during the postoperative period of mechanical ventilation. Awakening was rapid after cessation of the propofol infusion in all three patients. Thus, we believe that propofol is an alternative to other agents for sedation of children after surgical repair of acyanotic congenital heart disease.
H. Biihrer, MD P. Stroszczynski, MD J. Motsch, MD Department of Anesthesia University of Heidelberg Heidelberg, Germany
REFERENCES
1. Gottardis M, Khiint-Brady KS, Keller W, et al: Effect of prolonged sedation with propofol on serum triglyceride and cholesterol concentrations. Br J Anaesth 62:393-396,1989 2. Albanese J, Martin C, Lacarelle B, et al: Pharmacokinetics of tong-term propofol infusion used for sedation in ICU patients. Anesthesiology 73:214-217,199O 3. Harper SJ, Buckley PM, Carr K: Propofol and alfentanil
infusions for sedation in intensive therapy. Eur J Anaesthesiol 8:157-165, 1991 4. Taylor DH, Cook JH: Propofol infusion for paediatric sedation. Report of a case and review of the literature. Today’s Anaesthetist 2:121-122, 1987 5. Norreslet J, Wahlgren C: Propofol infusion for sedation of children. Crit Care Med 18:890-892, 1990
! ETTERS TO THE EDliGP
Hoarseness following coronary artery bypass surgery is usually attributed to endotrachcal intubation. However. i 1I internal mammary artery dissection, (2) laryngeal edema, or (3) arytenoid cartilage dislocation can account for thtq complication. Any patient with hoarseness lasting for more than 5 days should have indirect laryngoscopy to rule out recurrent laryngeal nerve palsy.
Pieme A. Castheiy, MD Division of Cardiac Anesthesia St Joseph’s Hospital Center Paterson. NJ James Labagnaru, MD Department of Otorhinolaryngology UMDNJ Newark, NJ REFERENCES 1. Pepopard SB, Dickens JH: Laryngeal injury following short-term intubation. Ann Otol Rhino1 Latyngol Y2:317, 1983
2. Phillips T, Green G: Left recurrent laryngeal nerve injury following internal mammary artery bypass. Ann Thorac Surg 43:440, 1987 3. Prasertwanitch Y, Schwartz JJH, Vandam LD: Arytenoid cartilage dislocation following prolonged endotracheal intubation. Anesthesiology 41516, 1974
Continuous
Sedation
of Postoperative
Pediatric Propofol
Cardiac
Surgical
Patients
with
To the Editor: Propofol is a short-acting intravenous anesthetic agent that has been used for total intravenous anesthesia. Recently, long-term infusion of propofol has been introduced to sedate critically ill patients.” We have found only two case reports describing the use of propofol to sedate children4,’ Until now, we have administered propofol postoperatively as a continuous infusion to three pediatric cardiac surgical patients. All three children aged 6 months to 2.5 years had uncomplicated patch closures of ventricular septal defects. Intraoperatively, flunitrazepam and fentanyl were given as anesthetic agents. Postoperatively, controlled mechanical ventilation was continued for 7 to 11 hours. Propofol as a continuous infusion at a dose of 2 to 2.5 mg/kg/h was started on arrival in the intensive care unit. All routine laboratory parameters remained within normal levels. In each case, extubation of the trachea was possible within 10 to 20 minutes after stopping the propofol infusion. In our pediatric patients, propofol provided adequate sedation during the postoperative period of mechanical ventilation. Awakening was rapid after cessation of the propofol infusion in all three patients. Thus, we believe that propofol is an alternative to other agents for sedation of children after surgical repair of acyanotic congenital heart disease.
H. Biihrer, MD P. Stroszczynski, MD J. Motsch, MD Department of Anesthesia University of Heidelberg Heidelberg, Germany
REFERENCES
1. Gottardis M, Khiint-Brady KS, Keller W, et al: Effect of prolonged sedation with propofol on serum triglyceride and cholesterol concentrations. Br J Anaesth 62:393-396,1989 2. Albanese J, Martin C, Lacarelle B, et al: Pharmacokinetics of tong-term propofol infusion used for sedation in ICU patients. Anesthesiology 73:214-217,199O 3. Harper SJ, Buckley PM, Carr K: Propofol and alfentanil
infusions for sedation in intensive therapy. Eur J Anaesthesiol 8:157-165, 1991 4. Taylor DH, Cook JH: Propofol infusion for paediatric sedation. Report of a case and review of the literature. Today’s Anaesthetist 2:121-122, 1987 5. Norreslet J, Wahlgren C: Propofol infusion for sedation of children. Crit Care Med 18:890-892, 1990
