Pro: Early Extubation After Pediatric Cardiac Surgery

Faraoni, David; Ng, William C. K.

doi:10.1053/j.jvca.2020.05.025

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…On-table extubation has been performed with an increasing frequency at our institution in recent years. However, which patients benefit most from early extubation, and in which patients an early extubation strategy leads to increased risk for perioperative complications has not been objectively evaluated [ 18 , 19 ]. Therefore, the aim of this study was to assess, whether on table extubation is a safe procedure and to evaluate potential benefit from early extubation.…”

Section: Discussionmentioning

confidence: 99%

“…However, on-table extubation (OTE) after pediatric cardiac surgery is not the standard procedure and regularly performed at some centers only [ 17 ]. Reasons for commonly performed delayed extubation (DET) after transfer to intensive care unit are various including caution of early postoperative bleeding or concern about difficult to assess and manage combined respiratory and circulatory insufficiency [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Effects of on-Table Extubation after Pediatric Cardiac Surgery

Baehner

Pruem

Vergnat

et al. 2022

JCM

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Background: Enhanced recovery after surgery (ERAS) protocols are utilizing a multidisciplinary approach, reassessing physiology to improve clinical outcomes, reducing length of hospital stay (LOS) stay, resulting in cost reduction. Since its introduction in colorectal surgery. the concept has been utilized in various fields and benefits have been recognized also in adult cardiac surgery. However, ERAS concepts in pediatric cardiac surgery are not yet widely established. Therefore, the aim of the present study was to assess the effects of on-table extubation (OTE) after pediatric cardiac surgery compared to the standard approach of delayed extubation (DET) during intensive care treatment. Study Design and Methods: We performed a retrospective analysis of all pediatric cardiac surgery cases performed in children below the age of two years using cardiopulmonary bypass at our institution in 2021. Exclusion criteria were emergency and off pump surgeries as well as children already ventilated preoperatively. Results: OTE children were older (267.3 days vs. 126.7 days, p < 0.001), had a higher body weight (7.0 ± 1.6 kg vs. 4.9 ± 1.9 kg, p < 0.001), showed significantly reduced duration of ICU treatment (75.9 ± 56.8 h vs. 217.2 ± 211.4 h, p < 0.001) and LOS (11.1 ± 10.2 days vs. 20.1 ± 23.4 days; p = 0.001) compared to DET group. Furthermore, OTE children had significantly fewer catecholamine dependencies at 12-, 24-, 48-, and 72-h post-surgery, while DET children showed a significantly increased intrafluid shift relative to body weight (109.1 ± 82.0 mL/kg body weight vs. 63.0 ± 63.0 mL/kg body weight, p < 0.001). After propensity score matching considering age, weight, bypass duration, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Mortality (STATS)-Score, and the outcome variables, including duration of ICU treatment, catecholamine dependencies, and hospital LOS, findings significantly favored the OTE group. Conclusion: Our results suggest that on-table extubation after pediatric cardiac surgery is feasible and in our cohort was associated with a favorable postoperative course.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of on-Table Extubation after Pediatric Cardiac Surgery

Baehner

Pruem

Vergnat

et al. 2022

JCM

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“…Analgesia treatment after cardiac surgery needs to be given sufficient attention and treated actively. In a patient undergoing ultrafast track anesthesia, the tracheal tube will be removed early, which requires professional sedation and pain control management by the anesthesiologist to ensure normal spontaneous breathing and the patient’s comfort and to promote fast recovery [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of dexmedetomidine combined with sufentanil on postoperative analgesia for transthoracic device closure of ventricular septal defects in children with ultrafast track anesthesia

Wang

Xie

Lei

et al. 2021

J Cardiothorac Surg

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Background To observe the effect of combining dexmedetomidine with sufentanil on postoperative analgesia in children who underwent transthoracic device closure of ventricular septal defects (VSDs) with ultrafast track anesthesia. Methods This was a retrospective study. Eighty-seven children who underwent transthoracic device closure of VSDs were retrospectively analyzed. Patients were divided into three groups based on the different drugs used for postoperative patient-controlled analgesia. Results No statistically significant differences in hemodynamic parameters were noted among the three groups after surgery (p > 0.05). The FLACC score in the SD2 group was significantly greater than those in the S groups and SD1 groups after surgery (p < 0.001). The Ramsay score in the S group was significantly lower than that of the SD1 and SD2 groups at 6 h (p < 0.001 and p = 0.003), 12 h (p = 0.002 and p = 0.012), and 24 h (p < 0.001 and p < 0.001) after surgery. The pressing frequency of the analgesic pump 48 h after the operation in the SD2 group was significantly greater than that in the other two groups (p < 0.05). The incidences of respiratory depression, nausea, and vomiting in the S group were significantly greater than those in the SD1 and SD2 groups (p < 0.05). Conclusion The combination of 0.04 μg/kg/h dexmedetomidine and 0.04 μg/kg/h sufentanil intravenous analgesia was more effective than the other two analgesic strategies in children who underwent transthoracic device closure of ventricular septal defects (VSDs) with ultrafast track anesthesia.

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“…The perioperative outcome of these procedures may be enhanced by applying an adapted enhanced recovery after surgery (ERAS) regimen supported by evidence [9]. We ran this study to test the viability, safety, and efficacy of a modified ERAS pathway for patients requiring immediate small intestinal resection [10].…”

Section: Introductionmentioning

confidence: 99%

Comparison between Early and Standard Oral Feeding After Emergency Bowel Surgery

Khan¹,

Ahmad²,

Jamil³

et al. 2022

PJMHS

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Background: Laparotomy for small intestinal diseases accounts for a sizable proportion of all emergency operations. The perioperative outcome of these procedures may be enhanced by applying an adapted enhanced recovery after surgery (ERAS) regimen supported by evidence. Aim: This research aimed to appraise the outcomes of near-the-beginning feeding to those of normal eating in patients who had undergone emergency surgery on their digestive tracts (GI) or bowels. Methodology: This study was conducted at the departments of general surgery HMC Peshawar and Nishtar Hospital, Multan. Between November 2021 and April 2022, the data was collected from 84 patients who required emergency intestinal resection and anastomosis. Patients were not eligible if they had short bowel syndrome, intestinal ischemia, protracted bowel perforation, or septic shock. The patients were divided into two groups, those who began eating earlier (group E; n=44) and those who began eating later (group L; n=40). Early feeding entailed starting enteral nutrition within 48 hours of surgery. The surgical and clinical outcomes of the early feeding group were appraised to those of the late feeding cluster. Results: Bowel perforation was the most prevalent reason for surgery, and the miniature intestine was nearly all common areas affected. There was no meaningful difference in the origins, places, or interventions between the two sets of participants. Group L, on the other hand, had a much higher incidence of pulmonary issues (13.6 per cent vs 47.5 per cent, p=0.001) and an extended mean length of stay (LOS) in the ICU (2 days vs 1 day, p=0.038) and hospital (9 days vs 12 days, p=0.012).

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Pro: Early Extubation After Pediatric Cardiac Surgery

Cited by 10 publications

References 23 publications

Effects of on-Table Extubation after Pediatric Cardiac Surgery

Effects of on-Table Extubation after Pediatric Cardiac Surgery

Clinical effect of dexmedetomidine combined with sufentanil on postoperative analgesia for transthoracic device closure of ventricular septal defects in children with ultrafast track anesthesia

Comparison between Early and Standard Oral Feeding After Emergency Bowel Surgery

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