Fast-Track Extubation in Pediatric Cardiothoracic Surgery in Developing Countries

Iezzi, Federica; Summa, Michele di; Sarto, Paolo Del; Munene, James

doi:10.1055/s-0037-1604334

Cited by 5 publications

(8 citation statements)

References 7 publications

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“…In addition, we have still multiple controversial problems to deal with. Heterogeneity of pre- and intra-operative risk factors for complicated early extubation or predictors of prolonged mechanical ventilation are in this list ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of On-table Extubation After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial

et al. 2018

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BackgroundThe use of short-acting anesthetics, muscle relaxation, and anesthesia depth monitoring allows maintaining sufficient anesthesia depth, fast recovery, and extubation of the patients in the operating room (OR). We evaluated the feasibility of extubation in the OR in cardiac surgery.MethodsThis clinical trial was performed on 100 adult patients who underwent elective noncomplex cardiac surgery using cardiopulmonary bypass. Additional to the routine monitoring, the patients’ depth of anesthesia and neuromuscular blocked were assessed by bispectral index and nerve stimulator, respectively. In the on-table extubation (OTE) group (n = 50), a limited dose of sufentanil (0.15 µg/kg/h) and inhalational anesthetics were used for early waking. In the control group (n = 50), the same anesthesia-inducing drugs were used but the dose of sufentanil during the operation was 0.7 - 0.8 µg/kg/h. After the operation, cardiorespiratory parameters and ICU stay were documented.ResultsDemographic and clinical variables were comparable in both study groups. In the OTE group, we failed to extubate two patients in the OR (success rate of 96%). There were no significant differences between the two groups in terms of systolic and diastolic blood pressure at the time of entering the ICU (P > 0.05). Heart rate was lower in the OTE than in the control group at ICU admission (89.4 ± 13.1 vs. 97.6 ± 12.0 bpm; P = 0.008). The ICU stay time was lower in the OTE group (34 (21.5 - 44) vs. 48 (44 - 60) h; P = 0.001).ConclusionsCombined inhalational-intravenous anesthesia along with using multiple anesthesia monitoring systems allows reducing the dose of total anesthetics and maintaining adequate anesthesia depth during noncomplex cardiac surgery with cardiopulmonary bypass. Thus, extubation of the trachea in the OR is feasible in these patients.

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Section: Discussionmentioning

confidence: 99%

Feasibility of On-table Extubation After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial

et al. 2018

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“…Although ‘early extubation’ [extubation within the operating theatre or less than eight hours after a child's admission to PICU ( 17 , 18 )] has been described in the literature ( 19 , 20 ), mechanical ventilation following cardiac surgery in children remains common practice ( 21 ). However, on reviewing the limited quantity of readily available literature, there is support for early extubation of appropriate patients.…”

Section: Discussionmentioning

confidence: 99%

“…Further studies and case reports have suggested that early extubation in children following cardiac surgery can be achieved without an increase in post-operative complications, or adverse effects on cardiac function ( 17 , 28 ). Within PICU in established cardiac centres in high-income countries, early extubation is actively encouraged for some post-operative cardiac conditions where extubation is physiologically favourable (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…The development of new and improved anaesthetic agents including inhalational anaesthetics, short-acting opioids, hypnotics and sedatives with favourable pharmacodynamics (particularly with respect to depression of cardiac function) make the concept of early extubation following cardiac surgery possible if the process of anaesthesia is both well planned and well managed in appropriately selected patients ( 17 ). As these drugs and anaesthetic techniques become more readily available in low-income and middle-income countries (or can be provided by the visiting team), early extubation of paediatric cardiac patients can be achieved safely during surgical missions ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

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A Case Report Examining Early Extubation Following Congenital Heart Surgery in a Low Resource Setting

Howes

2019

Front. Pediatr.

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This case report aims to critically analyse the evidence surrounding early extubation in the post-operative phase following complex congenital cardiac surgery. Child A was an 8 year old female who had undergone complex congenital cardiac surgery during an international surgical charity mission. On admission to the paediatric intensive care unit Child A appeared to be in good condition and no major complications had occurred intra-operatively. This was considered alongside the situational pressures of resource limitations and the mission's aim to offer surgery to as many children as possible during the available time frame. The decision was made by the team that Child A was a suitable candidate for ‘early extubation.’ Some members of the team were uncomfortable with this approach and felt it could lead to poorer outcomes for patients. Current evidence surrounding early extubation both within international surgical mission trips to low-income and middle-income countries and established cardiac centres within high-income countries is examined and discussed alongside the context of resource limitation. Although the process and implications of early extubation following cardiac surgery needs further research, on the basis of the evidence currently available clinicians could potentially encourage the use of early extubation within clinical practice (for appropriately selected patients) through the utilisation of a multidisciplinary approach, both within the UK and during international surgical charity missions to low-income and middle-income countries.

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“…It becomes practicable by implementation of multidisciplinary patient management strategies. 4 A decreased rate of postoperative low cardiac output syndrome and mortality is seen in the fast track group. 5 FTA is cost-effective without increase in complications and this has led to the universal adoption of this protocol.…”

Section: Introductionmentioning

confidence: 98%

Comparison of Ultrafast Tracking Anesthesia versus Conventional Strategy in Postoperative Management of Off-Pump Coronary Artery Bypass Surgery

Nagre

2018

J Card Crit Care

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Introduction Conventional strategy in the postoperative ventilation was a long-established practice in former times but now fast tracking is an acknowledged technique. This study was embarked to assess the impact of ultrafast tracking on patient recovery and length of stay in intensive care unit (ICU) compared with conventional methods in off-pump coronary artery bypass (OPCAB) patients. Methods Fifty patients were enrolled in each group. Exclusion criteria were patients with ejection fraction > 30%, hemodynamically unstable, on intra-aortic balloon pump, associated valvular heart disease, and intraoperative conversion to on-pump coronary artery bypass grafting. Ultrafast tracking of anesthesia (UFTA) protocol included induction with low dose fentanyl, propofol, and vecuronium. Maintenance of anesthesia was done with sevoflurane, fentanyl, and atracurium whereas analgesia was done with tramadol and paracetamol. Results Statistical analysis was done with SPSS 21.0 program. Fischer’s test, chi-square test, independent t-test/Mann–Whitney U tests were used for calculations. Extubation time was statistically significant (p = 0.0001). Shift to ward was 3.96 ± 0.73 days in UFTA group and 4.34 ± 0.66 days in conventional group which proved statistically significant (p = 0.0073). No patients in both groups had postoperative myocardial infarction, stroke, low cardiac output, or mediastinitis. Renal failure and mortality were 2% in conventional group. Hypothermia, pacemaker dependency, blood transfusion, inotrope score, atrial fibrillation, re-exploration, and reintubation were monitored. No reintubation occurred in UFTA group. Conclusion UFTA appears to be safe and effective in OPCAB patients with early shift from ICU without any major complications.

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Fast-Track Extubation in Pediatric Cardiothoracic Surgery in Developing Countries

Cited by 5 publications

References 7 publications

Feasibility of On-table Extubation After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial

Feasibility of On-table Extubation After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial

A Case Report Examining Early Extubation Following Congenital Heart Surgery in a Low Resource Setting

Comparison of Ultrafast Tracking Anesthesia versus Conventional Strategy in Postoperative Management of Off-Pump Coronary Artery Bypass Surgery

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