Objective To summarize the anesthesia management and surgical characteristic of modified extended Morrow procedure in treating hypertrophic obstructive cardiomyopathy (HOCM). Methods This retrospective study was conducted in 139 patients (male 83 and female 56)aged from 1 1 to 66 years.They underwent general anesthesia by high dose intravenous fentanyl or sufentanyl combined with propofol infusion and low concentration sevoflurane inhalation.The surgeons chose ap-propriate surgical procedures,including modified extended Morrow procedure,or combined with mi-tral valve repair (replacement)and coronary artery bypass grafting,etc.All patients received intraop-erative transesophageal echocardiography (TEE ) or epicardial echocardiography monitoring. Results There was no death case in hospital.All patients were hemodynamically stable and there were no malignant adverse events such as ventricular fibrillation during perioperative period.70 (50.4%)of patients automatically recovered to cardiac rhythm after aortic unclamping,and 1 1 (7.9%)of patients needed temporary pacemaker due to atrioventricular block.Cardiopulmonary by-pass (CPB)were weaned off successfully without positive inotropic drugs in 103(74.1%)of patients, while others 36(25.9%)needed low dose dopamine,epinephrine or norepinephrine to maintain hemo-dynamics stable.The CPB time was (142 ± 5 1 )min and the time of aortic clamping was (96 ± 37 ) min.Blood protection was used in all patients and 129 (92.8%)of the patients didn’t receive any blood product.Conclusion Modified extended Morrow procedure was a safe and effective surgical pro-cedure for treatment of HOCM.Experienced teamwork was essential to achieve satisfactory clinical results.The key points of anesthesia management were administration of appropriate preoperative drugs,maintaining adequate anesthesia depth,appropriate preload and afterload,heart rate and rhythm.Intraoperative TEE monitoring was the golden standard for guiding and evaluating the effec-tiveness of the surgical procedures.Meanwhile protection of myocardium,lung,brain and blood can help to obtain satisfactory clinical outcomes.

Objective: Compared with ketamine anesthesia, to investigate sevoflurane inhalation combining laryngeal mask airway for anesthesia induction in pediatric cardiac surgery.
Methods:A total of 40 pediatric patients with congenital heart diseases received elective cardiac surgery in our hospital from 2013-08 to 2014-01 were studied. The children were from 6 months to 2 years of age and randomly divided into 2 groups, n=20 in each group. Sevolfurane group, the children inhaled the mixture of 8%sevolfurane and 100%O2, laryngeal mask airway was used upon losing consciousness for mechanical ventilation, the anesthesia was maintained by (3-4)% sevolfurane inhalation to facilitate central venous catheter placement. Ketamine group, the children received intramuscular injection of ketamine (7 mg/kg)+atropine (0.01 mg/kg). The peripheral venous line was established upon losing consciousness, the intravenous midazolam (0.1 mg/kg), pipecuronium (0.10 mg/kg), fentanyl (5 μg/kg) were applied, then tracheal intubation was performed for mechanical ventilation and the anesthesia was maintained by (0.5-1)%sevolfurane to facilitate central venous catheter placement.
Results: Sevoflurane group had the shorter time for losing the consciousness than that in Ketamine group (48.90 ± 3.93) s vs (577.85 ± 116.41) s, P<0.05 and the shorter time for ifnishing the central venous catheter placement (11.15 ± 2.48) min vs (24.15 ± 4.02) min, P<0.05. The average blood pressure and heart rate were similar between 2 groups after laryngeal mask or tracheal intubation, P>0.05. The arterial PH value, PaCO2, BE and lactatein were similar between 2 groups, P>0.05.
Conclusion: Sevoflurane inhalation combining laryngeal mask airway could shortening anesthesia preparation time with simple management. It provided an important anesthesia option in pediatric cardiac surgery.