title: An institutional experience with epidural analgesia in children and young adults undergoing cardiac surgery.
abstract: BACKGROUND
  Allowing spontaneous respiration after cardiac surgery eliminates complications related to mechanical ventilation and optimizes cardiopulmonary interaction. Epidural analgesia has been proposed to promote early extubation after cardiac surgery.
  
  
  OBJECTIVE
  To identify the characteristics of patients with epidural analgesia and safety profiles with respect to the timing of extubation following cardiac surgery.
  
  
  METHODS
  A retrospective chart review of patients who underwent cardiac surgery during a 5-year period. Demographic, procedural, and perioperative variables were analyzed to investigate factors that affect the timing of extubation.
  
  
  RESULTS
  A total of 750 records were reviewed. The patients' median age was 12 months, and 52% were infants (<1 year). Seventy-five percent of the patients utilized cardiopulmonary bypass. The study population was classified into three groups according to the timing of extubation: 66% were extubated in the operating room or upon arrival at the PICU (Immediate), 15% were extubated within 24 h (mean, 10.8 h; 95% CI, 9.0-12.6) (Early), and 19% were extubated after 24 h (Delayed). For the Immediate and Early groups, multivariate logistic regression identified young age, increased cross-clamp time, and inotrope score as independent risk factors for the need for mechanical ventilation. Postextubation respiratory acidosis (mean P(a)CO(2), 50 mmHg; 95% CI, 49-51) was well tolerated by all patients. There were no neurologic complications related to the epidural technique.
  
  
  CONCLUSIONS
  Epidural analgesia in children undergoing cardiac surgery provides stable analgesia without complications in our experience.
authors.affiliation: West Virginia University, Morgantown, WV 26506, USA. sthammasitboon@hsc.wvu.edu
authors.forename: Satid
authors.initials: S
authors.lastname: Thammasitboon
authors.forename: David A
authors.initials: DA
authors.lastname: Rosen
authors.forename: Riad
authors.initials: R
authors.lastname: Lutfi
authors.forename: Brian A
authors.initials: BA
authors.lastname: Ely
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weber
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Hilvers
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gustafson
mesh_terms: D000138:Acidosis / Q000097:blood; D000293:Adolescent; D000316:Adrenergic alpha-Agonists; D015360:Analgesia, Epidural / Q000009:adverse effects; D000769:Anesthesia, Inhalation; D000779:Anesthetics, Local; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D003000:Clonidine; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009294:Narcotics; D011183:Postoperative Complications / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000316:Adrenergic alpha-Agonists; D000779:Anesthetics, Local; D009294:Narcotics; D003000:Clonidine