title: Safety profile of fast-track extubation in pediatric congenital heart disease surgery patients in a tertiary care hospital of a developing country: An observational prospective study.
abstract: OBJECTIVE
  Early extubation after cardiac operations is an important aspect of fast-track cardiac anesthesia. In order to reduce or eliminate the adverse effects of prolonged ventilation in pediatric congenital heart disease (CHD) surgical patients, the concept of early extubation has been analyzed at our tertiary care hospital. The current study was carried out to record the data to validate the importance and safety of fast-track extubation (FTE) with evidence.
  
  
  METHODS
  A total of 71 patients, including male and female aged 6 months to 18 years belonging to risk adjustment for congenital heart surgery-1 category 1, 2, and 3 were included in this study. All patients were anesthetized with a standardized technique and surgery performed by the same surgeon. At the end of operation, the included patients were assessed for FTE and standard extubation criteria were used for decision making.
  
  
  RESULTS
  Of the total 71 patients included in the study, 26 patients (36.62%) were extubated in the operating room, 29 (40.85%) were extubated within 6 h of arrival in cardiovascular intensive care unit and 16 (22.54%) were unable to get extubated within 6 h due to multiple reasons. Hence, overall success rate was 77.47%. The reasons for delayed extubation were significant bleeding in 5 (31.3%) cases, hemodynamic instability (low cardiac output syndrome) in 4 (25%) cases, respiratory complication in 2 (12.5%), bleeding plus hemodynamic instability in 2 (12.5) cases, hemodynamic instability, and respiratory complication in 2 (12.5%) cases and triad of hemodynamic instability, bleeding and respiratory complication in 1 (6.5%) case. There was no reintubation in the FTE cases.
  
  
  CONCLUSIONS
  On the basis of the current study results, it is recommended to use FTE in pediatric CHD surgical patients safely with multidisciplinary approach.
authors.affiliation: Department of Anaesthesia, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Mohammad Irfan
authors.initials: MI
authors.lastname: Akhtar
authors.affiliation: Department of Anaesthesia, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hamid
authors.affiliation: Department of Anaesthesia, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Fauzia
authors.initials: F
authors.lastname: Minai
authors.affiliation: Department of Nursing Services, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Amina Rehmat
authors.initials: AR
authors.lastname: Wali
authors.affiliation: Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan.
authors.lastname: Anwar-Ul-Haq
authors.affiliation: Department of Cardiac Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muneer
authors.initials: M
authors.lastname: Aman-Ullah
authors.affiliation: Department of Anaesthesia, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Khalid
authors.initials: K
authors.lastname: Ahsan
keywords: Cardiopulmonary bypass; Congenital heart disease; Fast-track extubation; Operating room; Pediatric; Risk adjustment for congenital heart surgery