Extubação precoce na sala de operação após cirurgia cardíaca infantil

Abstract

Extubação precoce na sala de operação após cirurgia cardíaca infantilEarly extubation of children in the operating room after cardiac surgery Abstract Introduction: Early extubation is related to short lenth of hospitalization and less complications.Objective: Data analisys from children extubated in the operating room after cardiac surgery with CPB.Methods: Retrospective data analisys. Results 104ABUCHAIM, DCS ET AL-Early extubation of children in the operating room after cardiac surgery Bras Cir Cardiovasc 2010; 25(1): 103-108 morphine 0.05 to 0.1 mg. The anesthesia before and after CPB was maintained by sevorane and, during CPB, by propophol. RevAfter median thoracotomy and heart exposure, it was administered a dosage of heparin 5 mg/kg, performed cannulation of the aorta and both cavas with diameters appropriate to the body surface of each patient and CPB carried out under moderate hypothermia at 25°C. The oxygenator (Edwards Life Sciences) was determined by the body surface. The cardioplegia used was the cold blood type with solution of ST Thomas (Braile Biomédica), administered in the aorta after clamping, induction dosage of 30ml/kg and repeated each 20 minutes with dosage of 20ml/kg. The hematocryt of CPB was maintained at a high level (24). The decision for extubation was made jointly by the anesthesiologist and the surgeon, at the end of thoracorraphy, individually, after evaluation of: hemodynamic stability (without vasoactive drugs), rhythm (sinus), presence of hemorrhage, cardiopathy type and age (over neonatal period).At the end of surgery, the patients were transferred to the neopediatric intensive care unit, using a Venturi oxygen mask at 50% and there were collected biochemical exams after 30 minutes of arrival.The Aristotle Score Risk was determined after filling out the clinical data in the chart available at the site www.aristotleinstitute.org [2].The statistical analysis was performed with the Student's t test, considered significant with P value lower than 0.05. RESULTSIn the period from 3/29/2006 to 1/29/2008, 70 patients aged less than 18 years of age were operated at the Hospital Santa Catarina -Blumenau, with diagnostic of congenital cardiopathy. Among these, 20 patients were submitted to procedures without CPB (ligation of arterial conduit, section of vascular ring, bandage of pulmonary artery, correction of aortic coarctation and pericardial window) and 50 patients were submitted to procedures with CPB (atriosseptoplasty, ventriculosseptoplasty, atrioventricular septal defect, Ebstein anomaly, Jatene operation, supravalvar aortic stenosis, partial septal defect, double outlet right ventricle, subaortic membrane, correction of complex cyanotic cardiopathies using procedures type modified Blalock-Taussig, Glenn or Fontan, intracardiac foreign body, Tetralogy of Fallot, cor triatriatum. Fifteen children, aged 4 to 216 months (mean 76.1 months), were submitted to extubation in the operating room after correction of congenital cardiopathies, using cardiopulmonary bypass. There were exc...

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

“…Over the last decade, many retrospective studies have demonstrated the safety of fast tracking, with early tracheal extubation after cardiac surgery (19–26). 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).…”

Risk Factors for Delayed Extubation after Ventricular Septal Defect Closure: a Prospective Observational Study

“…Low cardiac output syndrome (LCOS) was defined as clinical signs or symptoms (tachycardia, oliguria, poor perfusion, cold extremities, hypotension, lowered level of consciousness, cardiac arrest) with or without a widened arterial-mixed venous oxygen saturation difference or metabolic acidosis [ 14 , 15 ] . A stroke is any confirmed neurological deficit of abrupt onset caused by a disturbance in blood flow to the brain, when the neurologic deficit does not resolve within 24 hours.…”

Ventilatory weaning strategies for predicting extubation success in children following cardiac surgery for congenital heart disease: a protocol for a systematic review and meta-analysis

“… 2 9 The most critical decision related to the postoperative management of patients submitted to cardiac surgery is the right time for extubation. 10 …”

“…Early extubation and fast-tracking protocols have been largely described in children following cardiac surgery 4 6 7 9 10. Postoperative long-term mechanical ventilation is required for many cases, which is most related to complex surgical procedure, low age and weight or even critical illness prior to surgery 4 9…”

“…An abrupt or inadequate discontinuation of ventilatory support may result in clinical decline, necessity for reintubation, and longer duration of mechanical ventilation, with increased mortality 2 9. The most critical decision related to the postoperative management of patients submitted to cardiac surgery is the right time for extubation 10…”