Selective Early Extubation in Pediatric Cardiothoracic Surgery
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- Category: Vol. 77, December 2009
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Selective Early Extubation in Pediatric Cardiothoracic Surgery,HUSSEIN AL-DABOUBI and SULIEMAN HADDADIN
Abstract
Background: Early extubation after cardiac operation is an important aspect of fast-track cardiac anesthesia. In order to reduce or eliminate the adverse effect of prolong ventilation the concept of early extubation in pediatric age group has been examined at our institution.
Material and Methods: To allow rapid emergence, low-dose opioids modified anesthesia and continuous infusion of propofol supplemented with low concentration of inhaled agent were used. Intercostal nerve block was used in lateral thoracotomies. Contraindication to early extubation were prolonged cardiopulmonary bypass (CPB) (>2.5 hours), he-modynamic instability, uncontrolled bleeding, severe pulmo-nary hypertension and congestive heart failure.
Results: Of 82 consecutive patients, age ranging from 6 mon-14 yr, mean of 3.3 yrs. Extracardiac procedures in 15 cases (18.3%) and those on CPB were 67 (81.7%). No patient required reintubation during the first 24 hrs after operation. One patient was reintubated 48 after extubation for sputum retention. There was no mortality and the incidence of perio-perative morbidity was low.
Conclusion: Early extubation after pediatric cardiothoracic surgery can be safely achieved and is possible in the majority of patients.