The Use of Regional Catheters in Children Undergoing Repair of Aortic Coarctation

Otu, Chinedu; Vo, Victoria; Staffa, Steven J.; Yuki, Koichi; Sullivan, Cornelius A.; Quiñonez, Luis G.; Brown, Morgan L.

doi:10.1053/j.jvca.2021.02.032

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…We have demonstrated that there is 54% compliance with the full range of anesthetic interventions (i.e., administration of a loading dose of paracetamol and an NSAID, administering prophylactic antiemetics and the use of a local anesthetic technique) and this is an area which could be both developed/expanded and improved upon. There has been increasing interest in a variety of regional techniques in pediatric cardiac anesthesia (such as a single‐shot paravertebral block, fascial plane blocks, and catheter‐based techniques) which modestly add to total anesthesia time but likely have an opiate sparing effect, although it remains to be seen whether this is consistent with a reduction in ICU or total hospital length of stay 7–9 …”

Section: Discussionmentioning

confidence: 99%

“…There has been increasing interest in a variety of regional techniques in pediatric cardiac anesthesia (such as a single-shot paravertebral block, fascial plane blocks, and catheter-based techniques) which modestly add to total anesthesia time but likely have an opiate sparing effect, although it remains to be seen whether this is consistent with a reduction in ICU or total hospital length of stay. [7][8][9] We also continue efforts to define what constitutes successful ERP management and would suggest a composite metric including (i) achievement of anesthetic management goals, (ii) timely drain removal, (iii) ICU and (iv) HDU length of stay, and (v) total hospital stay as an example of this. Although we have prioritized early mobilization as an important pathway objective, we are continuing to work on defining and measuring this.…”

Section: Discussionmentioning

confidence: 99%

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Initial results from an enhanced recovery program for pediatric cardiac surgical patients

Murphy

Sale

Barlatay

et al. 2022

Pediatric Anesthesia

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Background: Over recent years, a number of enhanced recovery programs have appeared in first, adult colorectal surgery, and subsequently many other adult surgical specialties. Increasing interest in this approach to perioperative management in children culminated in the recent development of the first enhanced recovery pathway for pediatric intestinal surgery, endorsed by Enhanced Recovery after Surgery Society (ERAS®). In parallel, there has been increasing interest in the refinement of perioperative management of selected pediatric cardiac surgical patients, invariably referred to as "fast track" management. Initiatives have largely focused on duration of postoperative ventilation rather than on a much wider range of perioperative interventions to optimize recovery and ensure timely discharge after surgery. In our institution, a "Level 1" pediatric cardiac surgical center, we assembled a multidisciplinary team to design a comprehensive enhanced recovery pathway, based on ERAS® methodology, for selected cardiac surgical patients. After a lengthy period of planning, staff education, and preparation, we implemented the pathway at the end of November 2019. Methods:We conducted a prospective audit of the perioperative management and outcomes of the first 88 patients managed according to this enhanced recovery pathway over a 25-month period in our institution. Results:The mean age of the patients was 5.8 years (range 0.5-17.9), and the mean weight was 22.4 kg (range 6.6-57.2). Sixty-eight of the 88 patients were cardiopulmonary bypass cases. A total of 54% of patients received all four defined intraoperative anesthetic interventions (intravenous paracetamol, non-steroidal anti-inflammatory drug, antiemetic if aged more than 4 years, and use of a local anesthetic technique). A total of 89% of patients met the target extubation time of 6 h after administration of protamine. Median postoperative intensive care unit length of stay was 23.5 h (range 15.2-89.5). When compared to a historic control group, this represented a 22% reduction in median intensive care unit stay, although the total hospital length of stay remained unchanged. A total of 83% of patients met the target hospital discharge target of the fifth postoperative day. How to cite this article: Murphy T, Sale S, Gonzalez Barlatay F, et al. Initial results from an enhanced recovery program for pediatric cardiac surgical patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Initial results from an enhanced recovery program for pediatric cardiac surgical patients

Murphy

Sale

Barlatay

et al. 2022

Pediatric Anesthesia

View full text Add to dashboard Cite

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“…Lidocaine, bupivacaine, and ropivacaine have been studied but there is insufficient evidence to support any specific agent. [44][45][46][47][48][49][50][51] High Weak…”

Section: High Strongmentioning

confidence: 99%

Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline

et al. 2022

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Background: Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline. Methods: A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus Results: 60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations. Conclusions: Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.

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The Use of Regional Catheters in Children Undergoing Repair of Aortic Coarctation

Cited by 2 publications

References 15 publications

Initial results from an enhanced recovery program for pediatric cardiac surgical patients

Initial results from an enhanced recovery program for pediatric cardiac surgical patients

Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline

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