Early tracheal extubation after paediatric cardiac surgery: the use of propofol to supplement low‐dose opioid anaesthesia

Cray, Steven H.; Holtby, Helen; Kartha, Vyas M.; Cox, Peter N.; Roy, W. L.

doi:10.1046/j.1460-9592.2001.00706.x

Cited by 31 publications

(15 citation statements)

References 26 publications

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“…Rapid postoperative extubation may speed coronary artery bypass surgery patients off mechanical ventilation in hours after leaving the operating room. [46][47][48][49][50][51] Stroke rehabilitation begins in the ICU. [52][53][54] In the medical ICU, current excitement focuses on the dramatic gains resulting from rehabilitation during the ICU stay.…”

Section: Current Icu Practices That May Influence Survivorship and Thmentioning

confidence: 99%

The Burdens of Survivorship: An Approach to Thinking about Long-Term Outcomes after Critical Illness

Iwashyna

Netzer

2012

Semin Respir Crit Care Med

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Internationally accepted approaches to the study of functioning and disability can inform critical care practitioners and scholars in their study of functional limitations, disability, and quality of life after critical illness and intensive care. Therefore this article provides an introduction to the World Health Organization's International Classification of Functioning, Disability and Health (ICF). The Institute of Medicine has also recommended this approach for the study of disability. This conceptual framework divides potential problems as follows: problems in body structure and tissue, limitations in activity (i.e., functional limitations as assessed in standardized environments), and restrictions in participation (i.e., the inability to fulfill a social role). The ICF draws attention to effect modifiers that can prevent problems at one level from progressing (or conversely can hasten their progression) to profound decrements in a patient's quality of life. It is particularly relevant for studies of long-term outcomes after critical illness and post-intensive care syndrome (PICS). This article provides a discussion of the ICF specific to the intensive care unit and the disablement process, with particular attention to new opportunities for intervention and their implications for cost and quality of life.

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Section: Current Icu Practices That May Influence Survivorship and Thmentioning

confidence: 99%

The Burdens of Survivorship: An Approach to Thinking about Long-Term Outcomes after Critical Illness

Iwashyna

Netzer

2012

Semin Respir Crit Care Med

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“…2,[19][20][21][22] These studies are summarized in Table 3. Ten studies were excluded from this review for the following reasons: different intervention (7), [23][24][25][26][27][28][29] different target population (2), 21,30 and other reasons (1.) 8…”

Section: Qualitative Data Reviewmentioning

confidence: 99%

Early Extubation after Pediatric Cardiac Surgery: Systematic Review, Meta-analysis, and Evidence-Based Recommendations

Alghamdi¹,

Singh²,

Hamilton³

et al. 2010

Journal of Cardiac Surgery

108

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“…The key component of the anesthetic management of patients who are in the fast-track pathway is the use of lower total dose of opioid in addition to inhalational anesthetic agents, either alone (20) or in addition to other adjunct medications, such as propofol (27), or very short-acting opioids, such as remifentanil (28). Also, some advocate the use of regional techniques, such as thoracic epidurals or single-shot caudal morphine, to facilitate early extubation (19, 29, 30).…”

mentioning

confidence: 99%

The Role of Different Anesthetic Techniques in Altering the Stress Response During Cardiac Surgery in Children

Naguib

Tobias

Hall

et al. 2013

Pediatric Critical Care Medicine

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Objectives Our goal was to evaluate the role of three anesthetic techniques in altering the stress response in children undergoing surgery for repair of congenital heart diseases utilizing cardiopulmonary bypass in the setting of fast tracking or early tracheal extubation. Furthermore, we wanted to evaluate the correlation between blunting the stress response and the perioperative clinical outcomes. Design Prospective, randomized, double-blinded study. Setting Single center from December 2008 to May of 2011. Patients Forty-eight subjects (low-dose fentanyl plus placebo, n = 16; high-dose fentanyl plus placebo, n = 17; low-dose fentanyl plus dexmedetomidine, n = 15) were studied between ages 30 days to 3 years old who were scheduled to undergo repair for a ventricular septal defect, atrioventricular septal defect, or Tetralogy of Fallot. Methods Children undergoing surgical repair of congenital heart disease were randomized to receive low-dose fentanyl (10 mcg/kg; low-dose fentanyl), high-dose fentanyl (25mcg/kg; high-dose fentanyl), or low-dose fentanyl plus dexmedetomidine (as a 1 mcg/kg loading dose followed by infusion at 0.5mcg/kg/hr until separation from cardiopulmonary bypass. In addition, patients received a volatile anesthetic agent as needed to maintain hemodynamic stability. Blood samples were tested for metabolic, hormonal and cytokine markers at baseline, after sternotomy, after the start of cardiopulmonary bypass, at the end of the procedure and at 24 hours postoperatively. Measurements and Main Results Forty-eight subjects (low-dose fentanyl plus placebo, n = 16; high-dose fentanyl plus placebo, n = 17; low-dose fentanyl plus dexmedetomidine, n = 15) were studied. Subjects in the low-dose fentanyl plus placebo group had significantly higher levels of adrenocorticotropic hormone, cortisol, glucose, lactate, and epinephrine during the study period. The lowest levels of stress markers were seen in the high-dose fentanyl plus placebo group both over time (adrenocorticotropic hormone, p = 0.01; glucose, p = 0.007) and at individual time points (cortisol and lactate at the end of surgery, epinephrine poststernotomy; p < 0.05). Subjects in the low-dose fentanyl plus dexmedetomidine group had lower lactate levels at the end of surgery compared with the low-dose fentanyl plus placebo group (p < 0.05). Although there were no statistically significant differences in plasma cytokine levels between the three groups, the low-dose fentanyl plus placebo group had significantly higher interleukin-6:interleukin-10 ratio at 24 hours postoperatively (p < 0.0001). In addition, when compared with the low-dose fentanyl plus placebo group, the low-dose fentanyl plus dexmedetomidine group showed lower norepinephrine level from baseline at poststernotomy, after start of cardiopulmonary bypass, and end of surgery (p ≤ 0.05). Subjects in the low-dose fentanyl plus placebo group had more postoperative narcotic requirement (p = 0.004), higher prothrombin time (p ≤ 0.03), and more postoperative chest tube output (p < ...

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Early tracheal extubation after paediatric cardiac surgery: the use of propofol to supplement low‐dose opioid anaesthesia

Abstract: We found the propofol regimen to be satisfactory with a shorted ICU stay for these patients.

Cited by 31 publications

References 26 publications

The Burdens of Survivorship: An Approach to Thinking about Long-Term Outcomes after Critical Illness

The Burdens of Survivorship: An Approach to Thinking about Long-Term Outcomes after Critical Illness

Early Extubation after Pediatric Cardiac Surgery: Systematic Review, Meta-analysis, and Evidence-Based Recommendations

The Role of Different Anesthetic Techniques in Altering the Stress Response During Cardiac Surgery in Children

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