title: Determinants of immediate extubation in the operating room after total thoracoscopic closure of congenital heart defects.
abstract: OBJECTIVE
  This study was designed to assess the factors that influence immediate extubation following totally thoracoscopic closure of congenital heart defects.
  
  
  METHODS
  Clinical and operational data of 216 patients (87 males, average age 13.6 ± 10.9 years) were retrospectively analyzed. Atrial (ASD, n = 90) or ventricular septal defects (VSD, n = 126) were closed via a totally thoracoscopic approach. Ultra-fast-track anesthesia (UFTA) was used in all patients.
  
  
  RESULTS
  Immediate extubation in the operating room was successfully performed in 156 (72.2%) patients. A delayed extubation was completed in the intensive care unit in the remaining 60 (27.8%) patients. There was no significant difference in the age, sex, body weight, or type of congenital heart defect between the immediate and delayed extubation groups (p > 0.05). However, more patients in the delayed extubation group had severe preoperational pulmonary hypertension [8 (13.3%) vs. 4 (2.3%), p < 0.05]. The cardiopulmonary bypass time, aortic clamp time, and total duration of the surgery in the immediate extubation group were shorter than in the delayed extubation group (p < 0.05). Multivariate logistic regression analysis showed that preoperational pulmonary hypertension, duration of the surgery or cardiopulmonary bypass, and dosage of fentanyl used during the surgery were independent predictors for immediate extubation.
  
  
  CONCLUSIONS
  UFTA and immediate extubation in the operating room was feasible and safe in the majority of patients undergoing totally thoracoscopic closure of ASD or VSD. Preoperational pulmonary hypertension, duration of the surgery, and the dosage of fentanyl used for UFTA were the determining factors for immediate extubation.
authors.affiliation: Department of Anesthesiology, Liaocheng People's Hospital of Shandong University, Liaocheng, China.
authors.forename: Ai-Lan
authors.initials: AL
authors.lastname: Yu
authors.forename: Xing-Zhi
authors.initials: XZ
authors.lastname: Cai
authors.forename: Xiu-Juan
authors.initials: XJ
authors.lastname: Gao
authors.forename: Zong-Wang
authors.initials: ZW
authors.lastname: Zhang
authors.forename: Zeng-Shan
authors.initials: ZS
authors.lastname: Ma
authors.forename: Long-Le
authors.initials: LL
authors.lastname: Ma
authors.forename: Le-Xin
authors.initials: LX
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D060666:Airway Extubation / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005283:Fentanyl / Q000008:administration & dosage; D006344:Heart Septal Defects, Atrial / Q000453:epidemiology / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D009873:Operating Rooms; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D013997:Time Factors; D055815:Young Adult
chemical_list: D005283:Fentanyl