Thomas did well overnight (considering he just had extremely complicated surgery yesterday) and for that we are grateful!
Overnight he had several episodes of SVT (supraventricular tachycardia = very fast heart rate). This can be dangerous because when the heart is beating this fast, it isn't able to pump well enough to provide blood where it needs to go. This can cause decreases in blood pressure and other signs of decompensation. Luckily, Thomas's blood pressure didn't drop during these episodes, and the SVT responded quickly to a medication called Adenosine. He is also Digoxin and Precedex to help keep this under control. It is probably caused from irritability and stretching of the heart muscle from yesterday, and may be caused by some "tickling" from some of the wires in his heart.
He is on Milrinone, Dopamine, and Epi, and has weaned some on these meds.
Thomas also has significant chest wall edema (swelling). When you look at his chest xray from yesterday, you see about 1/2 inch of soft tissue (skin, fat, etc) on either side of his ribs. This morning he had about 2inches of soft tissue (mostly swelling this time) on each side of his ribs. Swelling is a known complication, which is why his chest was left open after surgery to allow room for this. We need his kidneys to get back into action so he can get rid of some of this fluid. Sometimes the kidneys can be slow to wake back up after being on heart-lung bypass, so he is on Lasix and Diuril (diuretics) to help with this.
Because he isn't urinating well, his body held on to the anesthesia longer. It usually takes 6-12h for kids to wake up after surgery. He isn't waking up much, but his toes and feet were responsive this morning, which was good. Also, the Precedex that he is on for his heart is a sedative, so it is hard to tell. Once he really wakes up he will be on Fentanyl.
He is on the ventilator, of course, and his settings have come way down. Yay!
His lactic acid level is monitored to follow his perfusion, and has come down from 98 (after surgery) to 24. We are happy about that!
He is on Vancomycin and Gentamicin to prevent infection since his chest is open (its covered, but still a huge risk for infection). He is on Heparin to protect his new Sano shunt in his heart.
He still won't be able to eat for a while, and they are resuming his TPN (nutrition through his IV).
The next goals for Thomas are for the swelling to decrease enough that they can close his chest, and the step after that is to get off the ventilator. Baby steps!!!
We are so thankful and grateful for everyone's prayers. They have sustained us and brought Thomas through this first surgery!
Here are our prayer requests for now:
1) Kidney function- pray that urine output will increase
2) SVT/arrhythmia- pray it will stop and be easily controlled with medication
3) Pray that his chest wall swelling will go down enough for his chest to be closed in the next few days
4) Pray that his overall fluid/swelling will go down so that he can be taken off the ventilator successfully after his chest is closed
5) Pray that he will wake up quickly to look at us :)
6) Pray that he won't have any issues with infection or bleeding
7) Please continue to pray for the nurses and doctors caring for Thomas.....they are amazing and we are so thankful!
Sorry for all of the medical jargon...but I have alot of nerdy buddies who like all the details. I say that in love, because I'm a nerd too :)