IntroductionOn-table extubation (OTE) Viz., extubation of the patient in the operating room immediately (usually within 15 minutes) after surgery, is not uncommonly Abstract Background: 'On-table extubation' (OTE) is a simple, cost-effective method promising wider applicability. Most congenital cardiac corrective surgeries involve post operative ventilatory support that lead to ventilator associated complications and cost overuns in elective Congenital Cardiac Surgery (CCS). The objective of the study is to assess the feasibility and safety of OTE in patients undergoing for CCS. Patients and Methods: A retrospective study of 58 consecutive patient's case sheets who underwent elective CCS at KJ Hospital Chennai, India under the Needy little hearts of KJ Research Foundation from August 2005 to June 2009 was made. Outcomes measured included OTE rate, incidence of re-intubation morbidity and mortality. Results: 58 patients underwent elective CCS during the study period -43 Atrial Septal Defect (ASD), and, 11 Ventricular Septal Defect (VSD), 3 Combined Atrial and Ventricular Septal, (ASD&VSD) and 1 Ventricular Septal Defect with Double-Chamber Right Ventricle (VSD & DCRV). Median age was 12 yrs and medianweight was 12 kg. Patients underwent cardiopulmonary bypass; median bypass time was 40 minutes and median cross-clamp time 18.57 minutes. OTE was achieved in all 58 patients. Primary outcome was that no patient required re-intubation and ventilation. Secondary outcomes were 5 patients developed complications. One patient developed lower respiratory infection complicating pulmonary oedema. Five had superficial wound infection and one, had migraine. None of these complications could be attributed to OTE. There was no mortality.Conclusion: OTE is feasible in selected patients undergoing CCS in with excellent outcomes and acceptable morbidity. It should be considered as an option in appropriate treatment protocols. (Ind J Thorac Cardiovasc Surg 2010; 26: 5-10)