title: Clinical and hemodynamic factors associated with the outcome of early extubation attempts after right heart bypass surgery.
abstract: Fast-track anesthesia with early extubation (EE) is playing an increasingly important role in pediatric cardiac surgery. We examined the pre- and intra-operative factors contributing to successful EE, and outcomes after right heart bypass surgery (RHB). We retrospectively reviewed the medical records of 71 consecutive children (median age=14 months) admitted over a 4-year period to the pediatric intensive care unit (PICU) of our university-based hospital, after RHB. We compared the characteristics and outcomes of 38 children (54%) extubated <3 h, with those of 33 (46%) extubated >or=3 h after surgery. Odd ratios (OR) and 95% confidence intervals (CI) were calculated. Variables associated with EE included a lower dose of intra-operative fentanyl (OR: 0.95; 95% CI, 0.92-0.99; P=0.03), nitroglycerin (OR: 0.23; 95% CI, 0.07-0.73; P=0.01), and a lower inotropic score (OR: 0.76; 95% CI, 0.61-0.94; P=0.01) on admission. EE was correlated with fewer postoperative respiratory complications (OR: 0.09; 95% CI, 0.02-0.57; P=0.01) and shorter stay in the PICU (OR: 0.88; 95% CI, 0.76-1.03; P=0.12). Our data suggest that EE after RHB could be facilitated in patients with a preserved cardiac function and lower pulmonary vascular resistance. EE could be followed by fewer postoperative pulmonary complications.
authors.affiliation: Department of Anesthesiology and Intensive Care, School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kurihara
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Shime
authors.forename: Takako
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Satoru
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007902:Length of Stay; D016015:Logistic Models; D008171:Lung Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage; D016017:Odds Ratio; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D005996:Nitroglycerin; D005283:Fentanyl