Brought Leif to 2JCW for pre-op at 5:45am. Blood match types lost, so blood had to be re-drawn. Apologies were given profusely. Parental consent was also lost, so Dr. Brown came and had us fill out a second consent form. We were then taken to the 5th floor to prepare for anethesia. Leif was busy watching everything going on around him. By 7:10 am, Leif was taken for surgery, and we waited in the PICU waiting room.
March 10, 1999 - Evening
At about 4pm, Dr. Calderone (the surgeon) found us. He said the reconstruction of Leif's aortic arch went well, as did the work on the pulmonary artery (PA). He said at the end, Leif's heart "sagged" but was fixed with drugs. Later, he said Leif had two periods of cardiac arrest. The BT shunt was left in. Leif had difficulties with low blood pressures and loss of blood. By 6:30pm, the problems had stabalized and we were able to see him. He had a femural line, a neck line, and IV with his femural line, a folie cathetar, three chest tubes, a nose drainage tube, a venthilator, and monitors. Oh - and pacemaker wires and rectal temperature probe. He was kept on a cooling blanket.
Stable. CVP pressure 10-13*. PAP 20-24. Pulse-ox at 80-85. Heart rates at 160-180. Leif was allowed to warm up a little. He was very swollen. Given lacix to help with fluids.
Still stable. Paralytic allowed to slow down, so he can move and hold our hands. Nitric oxide continues to be weaned (down from Wednesday at 10ppm). He got down to .5ppm. Chest tubes taken out. A problem with cathetars and high pressures - CVP 13-17. PAP 24-27. Dr. Calderone came at 4 and detected problem. Nitric oxide turned back up to 4 ppm, lots of blood and fluids were quickly drained. Leif's worse day of swelling.
BIG IMPROVEMENTS! Nitric oxide back to .5ppm. Lacix drip, fentanyl weaned to morhpine, vent to 15bpm. CVP 9-10, PAP 19-20, Blood pressure >100. Leif woke up a lot and would squirm around. Weight still up, indicating how swollen he is. Lacix working well enough that keeping up with potassium is a problem.
Big day. CVP 5-7, PAP 12-15. Nitric oxide turned off. Vent weaned to 8bpm w/ 30% oxygen. Heartrate 120-150. Captopril started saturday and increased sunday. Weight is 6.69 kg - 6.3 is pre-op weight. Able to wake up without blood pressure going so high. Lost neck line and rectal thermometer. He acted much more awake and comfortable. First day he really looked like Leif again.
Leif got his vent out, and it was switched for a C-PAP!!!! He got his pacemaker wires out mid-afternoon. Leif was awake a lot. He vomitted a lot of mucus, and afterwards he was "normal" baby color all over. His morphine was weaned WAY down. He got a NG-tube for feedings, and feeds were started at 10cc per hour. He went up to 20cc at 10pm. His CVP was 3-6 and his heartrate was 96 at one point. He weighs 6.19kg.
Leif got his C-PAP out. At 5pm he was moved to 2JCW (pediatrics). He began bottle feeding. He was on oxygen (1.5 litres p/h) His versaid and morphine were weaned down.
Leif was taken off oxygen and his sats stayed between 75-95. He hung out at about 90 all day. He began to take aspirin. Morphine and versaid almost off. He was very congested - still coughing a lot. A little fussy, but up most of the day wanting to play.
Leif home! Meds are aspirin, digoxin, captopril and lacix. We come back in a week for a cardiology check-up, but all looks good.
**CVP, PAP, etc are pressure checks of Leif's heart (i.e. Pulmonary artery pressure). Monitors were kept on, watching his heart closely to keep the pressures in the desired range.
