Anesthetic management of a child with double outlet right ventricle and severe polycythemia: A case report

BACKGROUND Double outlet right ventricle(DORV)is a rare and complex congenital heart defect,and the surgical repairs vary with type and pathophysiology consequences.Due to prolonged progressive hypoxemia,severe polycythemia is common in patients with DORV,which ultimately leads to coagulation dysfunction and increases the risk of thrombosis and infarction.Consequently,the anesthetic management is challenging and how to manage severe polycythemia and avoid hypoxia-related complications in such patients is of great significance.CASE SUMMARY Herein,we report the anesthetic management of a 10-year-old female patient with a DORV.She lived in the low-oxygen Qinghai-Tibet Plateau,and presented with severe polycythemia(hemoglobin,24.8 g/dL;hematocrit,75%).She underwent a modified Fontan surgery,which was satisfactory and without any perioperative complications.Our anesthetic management highlights the importance of perioperative hemodilution in decreasing the risk of thromboembolism and the importance of correcting coagulopathy in preventing hemorrhage.CONCLUSION Anesthetic management is challenging in rare cyanotic congenital heart disease patients with severe polycythemia.It is important to adopt perioperative hemodilution and correction of coagulopathy in preventing thrombosis and hemorrhage.

Salvianolic acid B decreases interleukin-1b-induced colitis recurrence in mice

Background:Degree of mucosal recovery is an important indicator for evaluating the therapeutic effects of drugs in treatment of inflammatory bowel disease(IBD).Increasing evidences has proved that tight junction(TJ)barrier dysfunction is one of the pathological mechanisms of IBD.The aim of this study was to observe whether enhancement of TJ can decrease colitis recurrence.Methods:Eighty C57BL/6 mice were randomly divided into four groups including normal group,colitis group,sulfasalazine(SASP)treated group,and traditional Chinese drug salvianolic acid B(Sal B)treated group.Colitis was established in mice by free drinking water containing dextran sulfate sodium,after treatments by SASP and Sal B,recombinant human interleukin-1b(IL-1b)was injected intraperitoneally to induce colitis recurrence.Results:Compared with sham control,cell apoptosis in colitis group was increased from 100.85±3.46%to 162.89±11.45%(P=0.0038),and TJ dysfunction marker myosin light chain kinase(MLCK)was also significantly increased from 99.70±9.29%to 296.23±30.78%(P=0.0025).The increased cell apoptosis was reversed by both SASP(125.99±8.45%vs.162.89±11.45%,P=0.0059)and Sal B(104.27±6.09%vs.162.89±11.45%,P=0.0044).High MLCK expression in colitis group was reversed by Sal B(182.44±89.42%vs.296.23±30.78%,P=0.0028)but not influenced by SASP(285.23±41.04%vs.296.23±30.78%,P>0.05).The recurrence rate induced by recombinant human IL-1b in Sal B-treated group was significantly lower than that in SASP-treated group.Conclusions:These results suggested a link between intestinal mucosal barrier dysfunction,especially TJ barrier dysfunction,and colitis recurrence.The TJ barrier dysfunction in remission stage of colitis increased the colitis recurrence.This study might provide potential treatment strategies for IBD recurrence.