Fast-Track Extubation in Pediatric Cardiothoracic Surgery in Developing Countries
29 September 2017 (online)
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.
- 1 Neirotti RA, Jones D, Hackbarth R, Paxson Fosse G. Early extubation in congenital heart surgery. Heart Lung Circ 2002; 11 (03) 157-161
- 2 Lake CL. Fast tracking in paediatric cardiac anaesthesia: an update. Ann Card Anaesth 2002; 5 (02) 203-208
- 3 Miller JW, Vu D, Chai PJ. , et al. Patient and procedural characteristics for successful and failed immediate tracheal extubation in the operating room following cardiac surgery in infancy. Paediatr Anaesth 2014; 24 (08) 830-839
- 4 DiNardo JA. Con: extubation in the operating room following pediatric cardiac surgery. J Cardiothorac Vasc Anesth 2011; 25 (05) 877-879
- 5 Mittnacht AJC, Hollinger I. Fast-tracking in pediatric cardiac surgery—the current standing. Ann Card Anaesth 2010; 13 (02) 92-101
- 6 Meissner U, Scharf J, Dötsch J, Schroth M. Very early extubation after open-heart surgery in children does not influence cardiac function. Pediatr Cardiol 2008; 29 (02) 317-320