[Early extubation with caudal morphine after pediatric heart surgery].
OBJECTIVE
To analyze the viability of immediate extubation of children after corrective surgery for congenital heart defects with extracorporeal membrane oxygenation using an anesthetic technique involving caudal morphine, and to study the effect on length of stay in the pediatric intensive care unit (PICU) or elsewhere in the hospital.


METHODS
Twenty-nine ASA I-II patients without coagulation alterations undergoing surgery to correct simple heart defects were selected for extubation after surgery. Anesthesia was provided with with sevoflurane, midazolam, rocuronium, fentanil (maximum dose 10 micrograms/Kg) and a bolus of caudal morphine (50-60 micrograms/Kg) after anesthetic induction. Patient characteristics, type of surgery, times of extracorporeal circulation and of ischemia, arterial blood gases upon arrival in the PICU, postoperative complications and quality of analgesia were the variables analyzed. We also compared length of stay in the PICU and hospital for the study group and for a historical control group of 23 patients who had no received caudal morphine or been selected for early extubation.


RESULTS
All patients were extubated satisfactorily in the operating room. None required reintubation or reoperation. Postoperative pain was controlled with metamizol alone for 79.3%. No episodes of respiratory depression or neurological complications were observed. PICU and hospital stays were significantly shorter in the study group than in the control group.


CONCLUSIONS
Of patients undergoing simple corrective heart surgery with extracorporeal membrane oxygenation immediate extubation did not increase postoperative morbimortality and shortened the hospital stay. A single dose of caudal morphine provided optimum conditions for extubation and good control of postoperative pain. Strict measures must be taken, however, to avoid postpuncture bleeding.
Figueira Moure
A
A
Servicio de Anestesiología y Reanimación, Complexo Hospitalario Universitario Juan Canalejo, A Coruña. homero2@inicia.es
Pensado Castiñeiras
A
A
Vázquez Fidalgo
A
A
Fernández Goti
C
C
Diéguez Fernández
M
M
Sanduende Otero
Y
Y
Sánchez Galindo
A
A
Ramil Fraga
C
C
Portela Torrón
F
F
Zavanella Botta
C
C
D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000763:Anesthesia, Caudal; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D004177:Dipyrone / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D004177:Dipyrone; D009020:Morphine
Extubación precoz con morfina caudal tras cirugía cardíaca pediátrica.