Background: By allowing patients to be extubated from their ventilators in the intensive care unit (ICU) as soon as they have stabilized, fast-track anesthesia (FTA) hastens the return to full awareness and independent breathing after surgery. Objective: In this study our main goa is to evaluate the role of fast track extubation in enhance recovery after pediatric cardiac surgery. Method: This prospective study was carried out at tertiary hospital from January 2021 from January 2022 where total of 200 CHD children, aged 6 months to 2 years and admitted to tertiary hospital, were selected for this study. During the study, 200 patients were randomly divided into two groups each consisting of 100 patients, and were subjected to fast track anesthesia and conventional anesthesia before surgeries. Results: During the study, in fast track anesthesia group mean age was 1.2 ± 0.5 years, followed by 55 cases were female, 47 were preterm patients, mean anesthesia times was 3.5 ± 1.2 h, mean surgery time was 295.1 ± 22.9 min, mean CPB time was 47.2 ± 11.8, mean block time or a total allocated amount of time for a surgeon was 30.2 ± 8.9. whereas in conventional anesthesia group, mean age was 1.1 ± 0.5 years, followed by 40 cases were female, 45 were preterm patients, mean anesthesia times was 3.2 ± 1.0 h, mean surgery time was 288.0 ± 20.5 min, mean CPB time was 46.2 ± 10.7, mean block time was 31.5 ± 9.1. in fast track group mean extubation time was 22.9 ± 3.5 min followed by mean postoperative hospital stay was 11.5 ± 3.0 days, besides that, at extubation SAS score was 3.8 ± 0.6a and 24h post operation SAS score was 4.0 ± 0.5. Whereas in conventional group mean extubation time was 189.1 ± 31.2 min followed by mean postoperative hospital stay was 16.1 ± 2.4, besides that, at extubation SAS score was 4.8 ± 0.7and 24h post operation SAS score was 3.9 ± 0.5. MAP, HR and CVP between children outcome was measured based different time interval (T0 to T5) Moreover, no significant changes were noticed between two group. The number of patients with ventilator-associated pneumonia was less in fast track group than in conventional group (P < 0.05). In fast track group arrhythmia cases were seen in 1% cases followed by 1% infection cases were seen, bleeding seen in 1%. Whereas in conventional group arrhythmia cases were seen in 2% cases followed by 1% infection cases were seen, bleeding seen in 2%. Conclusion: Fast Track Anesthesia generates stable hemodynamics during operation, shorter extubation time, shorter ICU and hospitalization stay without increase in adverse reactions. It is worthy of recommendation for clinical practice.
Background: Rapid tracheal extubation after cardiac surgery is not novel. "Fast-track management" has gained popularity in recent years, and the provision of cost-effective treatment is now included in with other factors as a means of assessing the success of various surgical procedures. Objective: In this study our main goal is to evaluate the effect of Analgesia in fast track pediatric cardiac patient. Method: This retrospective study was done at Bangladesh Shishu Hospital and Institute, Bangladesh, from January 2021 to January 2022. A total of 100 patients considered suitable for fast-track care were selected prior to surgery. The criteria for the selection of fast-track patients included low- risk cardiac surgery and the absence of other associated complex defects, either a weight over 10 kg or at least 6 months of age, the absence of complex non-cardiac issues and no significant history of repeat chest infections or obstructive airway disease. Results: during the study, mean age group was 5.7 years, followed by 55 cases were male, mean weight was 15.5 kg. 50% had a trial septal defect followed by 15% Ventricular septal defect, 11% Partial anomalous pulmonary, 9% congenital sabaortic stenosis, 10% had Atrioventricular septal defect. While reviewing post-operative faces pain score in day-1, 15% had no hurts followed by 60% had hurts a little bit, 10% had hurts more, 5% had hurts even more, 5% had hurts whole lot, 5% had hurts worst In day-2 25% had no hurts, 50% had hurts a bit, 12% had hurts a little more, 6% had hurts even more. In day-3 40% had no hurts, 40% had hurts a little bit, 20% had hurts little more. However, in day-4 15% had hurts little bit and 10% had hurts little more. In addition, 90% of the patients had between excellent and satisfactory analgesia. Moreover, 48% had vomiting and 2% had itching. Conclusion: The treatment of congenital heart disease after surgery is projected to become more reliant on "fast-track" care as the healthcare system ....
not availableBangladesh J Child Health 2015; VOL 39 (3) :154-156
Background: Acute kidney injury following cardiac surgery in children is a relatively common phenomenon. The risk ranges from 15% to 64% with a mortality rate of 10% to 89% for those who need dialysis. Objective: To identify the occurrence of acute kidney injury following cardiac surgery in children, as well as its consequences and treatment options. Methods: This study was conducted in the pediatric cardiac recovery center at Bangladesh Shishu Hospital & Institute from January 2019 to December 2020. Using the KDIGO (kidney disease improving global outcome) criteria, 50 children having cardiac surgery were assessed for the occurrence of AKI. Children were divided into two groups. The AKI group consists of 20 patients, whereas the non-AKI group consists of 30 patients. Age, sex, cardiac illness, past operations, RACHS-1 (Risk adjustment for congenital Heart surgery) and pre and post-operative creatinine levels were noted. Fisher’s exact test was used to determine whether or not AKI was associated with categorical factors, while the Mann- Whitney U-test was used to see whether or not AKI was associated with continuous variables. Results: Mean age of study population was 4.50±4.03 years for those who did not develop AKI and 7.55±5.79 years for those who did. Male constituted a majority in both groups. Despite the fact that patients with AKI were more acidotic at baseline, lower bicarbonate levels were not linked to an increased risk of AKI (p=0.89). Neither group had higher or lower pressure than the other. Time spent in bypass and crossclamping was comparable across AKI and non-AKI patients. Patients with AKI did not have a higher risk of developing extracellular fluid excess than non-AKI patients. There was no significant difference between the groups in terms of the average time spent on mechanical ventilation or total hospital stay in days (p=0.17 and p=0.62, respectively). Duration of stay in the cardiac recovery increased for patients who had AKI (p=0.02). The mortality rate among the AKI patients was 20% (4/14). In the control group without AKI, there was one death (3.33%) (p 0.0001). Conclusion: AKI is common complication of paediatric cardiac surgery. Prolong times spent on mechanical ventilation in the ICU and in the hospital have all been linked to AKI. DS (Child) H J 2021; 38(1): 44-48
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