Early tracheal extubation after paediatric cardiac surgery: the use of propofol to supplement low-dose opioid anaesthesia.
BACKGROUND
After institutional approval and parental consent, 103 children, aged 6 months to 18 years, who were undergoing repair of simple and complex congenital heart lesions using cardiopulmonary bypass (CPB) were studied and compared with a group of 135 children who had undergone similar surgery in our institution in the year before.


METHODS
Anaesthesia for study patients included fentanyl (< 20 microg.kg-1) and isoflurane. Infusions of propofol (median infusion rate 70 microg.kg-1.min-1) and morphine (median infusion rate 20 microg.kg-1.h-1) were started after weaning from CPB and continued postoperatively. Preestablished criteria were used in the intensive care unit (ICU) to assess readiness for tracheal extubation.


RESULTS
Median time from admission to ICU to tracheal extubation was 5 h. Fifty-six children were extubated within 6 h and 73 within 9 h of ICU admission. Mean ICU stay for study patients was 1.7 days [95% confidence interval (CI) 1.2-2.2] and 2.6 days (95% CI 2.3-2.9) in the comparison group (P<0.005).


CONCLUSIONS
We found the propofol regimen to be satisfactory with a shorted ICU stay for these patients.
Cray
S H
SH
Department of Anaesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada. steven.cray@bhamchildrens.wmids.nhs.uk
Holtby
H M
HM
Kartha
V M
VM
Cox
P N
PN
Roy
W L
WL
D000293:Adolescent; D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002648:Child; D002675:Child, Preschool; D005283:Fentanyl; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D007530:Isoflurane; D009020:Morphine; D015742:Propofol
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D009020:Morphine; D007530:Isoflurane; D005283:Fentanyl; D015742:Propofol