The effect of ultra-fast track cardiac anaesthesia in infants and toddlers: a randomised trial

Abstract

Background: The usefulness of ultra-fast track cardiac anaesthesia may give great benefits to patients; however, its usefulness has not been completely evaluated in infants and toddlers, who are generally considered the most difficult group for ultra-fast track cardiac anaesthesia. Method: A total of 130 children were allocated randomly into to a ultra-fast track cardiac anaesthesia group (Group D) or a conventional anaesthesia group (Group C) (each n = 65). In Group D, dexmedetomidine was administrated at a dosage of 1 µg/kg/hour after induction. The patient- controlled intravenous analgesia was dexmedetomidine and sufentanil. In Group C, patients were infused with of the same volume of normal saline, and sufentanil alone for patient-controlled intravenous analgesia. The dosages of sufentanil, extubation time, haemodynamic parameters, postoperative hospitalisation conditions, pain and sedation scores, blood gas analysis, and inotropic scores were all recorded. Results: The dosage of sufentanil (1.49 ± 0.05 vs. 3.81 ± 0.04 µg, p < 0.001) and extubation time (2.63 ± 0.52 vs. 436.60 ± 22.19 minutes, p < 0.001) in Group D were all significantly lower than those in Group C. Moreover, cardiac intensive care unit stay time, total hospital stay, hospitalisation costs, postoperative lactate levels, and inotropic scores were also significantly lower in Group D. Conclusions: Using of ultra-fast track cardiac anaesthesia in infants and toddlers is effective, it not only reduce the perioperative requirement for opioids and shorten the extubation time but also decreases the inotrope requirement and provide a better postoperative condition for young children.

Predictors of Extubation in the Operating Room after Pediatric Cardiac Surgery: A Single Center Retrospective Study

“…As previously published compelling evidence has established, early extubation and fast-track extubation result in shorter hospital stays (3,5,7,9,10). Early extubation enables early patient mobilization and verbal contact between the children and their surroundings.…”

“…In the literature, there are reports of the use of early extubation, including ultra-fast-track (UFT) extubation in a variety of congenital cardiac surgical procedures but yet controversies revolve around the topic (5,7,9). Clinical bene ts of early extubation following cardiac surgery include reduced ventilator-associated complications, reduced need for sedatives and decreased length of hospital stay (1,(3)(4)(5)(6)(7)(8).…”

“…In the literature, both weaning from mechanical ventilation within six to eight hours post-operatively, and as late as 24 hours have been referred to as 'early extubation' (1,2). While fast-track extubation refers to weaning of patients from mechanical ventilation within 6 hours post-operatively, ultra-fast track (UFT) extubation includes extubations performed in the operating room or within an hour (4,5). Although postoperative mechanical ventilation in the intensive care unit is still common practice in many institutions, early extubation including ultra-fast track extubation following surgery for congenital heart disease has been debated (2,3,(6)(7)(8)).…”

Comparison Between Fast-Track and Conventional Anesthesia for Children Undergoing Closure of Ventricular Septal Defects: A Systematic Review and Meta-Analysis

“…These opioids, together with inhaled or IV short-acting anesthetics, accomplish a fast return to voluntary breathing and circulation [ 10 ]. Furthermore, the use of fast-track anesthesia in young children also decreases the need for inotropes and yields a better perioperative outcome [ 11 ].…”

Predictors of extubation in the operating room after pediatric cardiac surgery: A single-center retrospective study

“…[2][3][4][5][6] In the literature, there are reports of the use of early extubation, including UFT extubation in a variety of congenital cardiac surgical procedures, but yet controversies revolve around the topic. [5,7,8] In this debate, benefits of the early extubation strategy were reported to reduce ventilator-associated complications, reduce the need for sedatives, and decrease the length of hospital stay. [1,[3][4][5][6][7]9] For the most part, congenital heart surgery patients can be extubated in the operating room.…”