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 ....
Ureteral reimplantation is one of the important components of reconstruction of urinary tract in renal transplantation. There are various techniques of ureteral reimplantation, of which Extravesical Lich-Gregoir is the ideal technique for renal transplantation. Extravesical ureteroneocystostomy to reestablish urinary tract continuity in renal transplantation has been examined through a study of 140 kidney transplants leading to the finding that stented anastomosis was associated with a lower urologic complication rate. We now report the urologic complication rate in our case series in which stented Lich–Gregoir anastomosis was routinely utilized. Methods. The records of 140 consecutive renal transplants were reviewed. Minimum follow-up time was 3 months. The standard anastomosis was a Lich–Gregoir with a 5-6 Fr cm D-J stent. Monitored urologic complications included postoperative vesicoureteral leak or ureteral necrosis, obstruction or stricture, or clinically significant hematuria. Results. One urologic complication were noted—one leak and no other complication. There were no stentrelated complications requiring reoperation. There were no cases in which the urologic complication led to graft loss or patient death. Conclusions. The urologic complication rate in this case series is less to the five previously published randomized trials, as well as our previous study. These results support the routine use of a ureteral stent Bangladesh Journal of Urology, Vol. 14, No. 2, July 2011 p.48-50
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