CC-BY-NC-ND 4.0 · J Card Crit Care 2017; 01(01): 021-023
DOI: 10.1055/s-0037-1604334
Original Article
Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound (ISCU)

Fast-Track Extubation in Pediatric Cardiothoracic Surgery in Developing Countries

Federica Iezzi
1  Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria, Ancona, Italy
,
Michele di Summa
2  Department of Cardiothoracic and Vascular Surgery, Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya
,
Paolo Del Sarto
3  Department of Anesthesia and Critical Care, Heart hospital “G. Pasquinucci,” Fondazione Toscana Gabriele Monasterio, Massa, Italy
,
James Munene
2  Department of Cardiothoracic and Vascular Surgery, Kenyatta National Hospital and University of Nairobi, Nairobi, Kenya
› Author Affiliations
Further Information

Publication History

Publication Date:
29 September 2017 (online)

Abstract

Objective In recent years, low-dose, short-acting anesthetic agents, which replaced the former high-dose opioid regimens, offer a faster postoperative recovery and decrease the need for mechanical ventilatory support. In this study, the aim was to determine the success rate of fast-track approach in surgical procedures for congenital heart disease.

Methods There is some evidence, mostly from retrospective analyses, that fast tracking can be beneficial. Ninety-one cases with moderate complex cardiac malformations were operated with fast-track protocol during cardiothoracic charitable missions. The essential aspects of early extubation in our cohort included selected patients with good preoperative status, good surgical result with hemodynamic stability in low dose of inotropic drugs at the end of bypass, and no active bleeding. In this setting, a careful choice and dosing of anesthetic agents, alongside a good postoperative analgesia are mandatory.

Results The authors found that an early extubation (< 4 hours) can be both effective and safe as it reduces intubation and ventilator times without increasing postoperative complications in pediatric congenital heart disease.

Conclusion This study supports a wider use of fast-track extubation protocols in pediatric patients submitted for congenital cardiac surgery in developing countries.