title: Fast-track postoperative care for neonatal cardiac surgery: a single-institute experience.
abstract: OBJECTIVE
  Perioperative fast-track management has gained wide acceptance in the field of neonatal corrective heart surgery. We have examined its impact on morbidity outcomes.
  
  
  METHODS
  Between 1997 and 2009, 52 consecutive neonates underwent corrective repair of congenital heart defects on cardiopulmonary bypass. Fast-track management was introduced in 2006 with the aim of simplifying care; it includes early postoperative extubation with low-dose fentanyl and an pulse oximeter oxygen saturation (SpO(2)) target of ≤ 95%, early removal of indwelling lines, and early introduction of early enteral feeding. This was a retrospective review of the medical records in which perioperative characteristics and outcomes of patients operated on prior to the introduction of fast-track management care (controls, group C) were compared with those operated on following its introduction (fast-track group, group F).
  
  
  RESULTS
  Intraoperative fentanyl was administered in significantly lower doses in group F (29.5 ± 11.5 μg/kg) than in group C (65.6 ± 34.0 μg/kg) (p < 0.001). The median number of days of postoperative mechanical ventilation and inotrope administration was significantly lower in group F (2 and 4 days, respectively) than in group C (9 and 9 days, respectively) (p < 0.001 and p = 0.003). More patients (p < 0.001) in group F (56.3%) than in group C (0%) was extubated within <24 h. The median number of days to postoperative weight recovery was significantly lower in group F (16 days) than in group C (29 days) (p = 0.003). Finally, the median number of days in the Intensive Care Unit was significantly lower (p = 0.01) in group F than in group C (16 vs. 26 days, respectively). Mortality in group F was 0% versus 17% in group C (p = 0.21).
  
  
  CONCLUSIONS
  Fast-track management with simple care for neonates undergoing complete biventricular repair of congenital heart defects was associated with better postoperative recovery.
authors.affiliation: Intensive Care Division, Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo-ku, Kyoto, 602-8566, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yamasaki
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Shime
authors.forename: Takako
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamagishi
authors.forename: Satoru
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D058109:Airway Management; D018685:Anesthetics, Inhalation; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D016292:Procedural Sedation; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D016343:Monitoring, Intraoperative; D011182:Postoperative Care / Q000379:methods*; D011300:Preoperative Care; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation