Eighty-five patients ranging from 12 h to 7 years of age were included in this study. In the first group 35 cases received
ketamine,
gallamine and
oxygen for surgery on the great vessels.
Ketamine provided satisfactory
analgesia and
amnesia. Heart rate did not change significantly.
Gallamine gave additional safety in the prevention of
bradycardia. One hundred per cent
oxygen increased oxygen saturation and made more
oxygen available for the tissues. The combination secured favorable conditions even in cases of sevre right to left shunt. Seven patients developed some degree of
bradycardia, requiring treatment. All but one responded to epinephrime infusion. The one who did not improve died on the table. There were 6 additional deaths during the first 48 postoperative hours. Fifty infants and children received
pentobarbital and
morphine premedication and
ketamine,
pancuronium,
nitrous-oxide oxygen anesthesia for open heart surgery. Cardiovascular stability with good operating conditions characterized the course of
anesthesia. The increase in systolic and diastolic blood pressures and heart rate was small after induction. Further changes in these parameters during
anesthesia were statistically insignificant. Perfusion pressure during cardio-pulmonary bypass was well maintained. The addition of 50 per cent
nitrous oxide to inhaled
oxygen significantly potentiated the duration of
hypnosis and
analgesia proved by
ketamine.
Mechanical ventilation was facilitated in both groups by the
analgesia extending well into the postoperative period. There were 6 deaths in the first 48 postoperative hours in this group. The state of consciousness at the end of
anesthesia and postoperative conditions of all 85 patients were comparable with that found with other agents. The techniques described provided suitable alternatives to the
anesthetic management pediatric cardiac surgery.