title: On-table Extubation after Open Heart Surgery in Children: An Experience from a Tertiary Care Hospital in a Developing Country.
abstract: BACKGROUND
  Recent advances in various disciplines of medicine have significantly changed the courses following cardiac surgery in children. On-table extubation (OTE) after open heart surgery in children is evolving.
  
  
  OBJECTIVE
  To assess the rate of postoperative complications in children extubated on table after open heart surgery.
  
  
  METHODS
  This is a retrospective, descriptive study.
  
  
  METHODS
  Operating room (OR) then admitted to the pediatric intensive care unit (PICU).
  
  
  METHODS
  All pediatric patients (between 0 and 18 years) undergoing open heart surgery between January 2011 and June 2013.
  
  
  METHODS
  On-table extubation.
  
  
  METHODS
  Rates of immediate postoperative complications, i.e., re-intubation, significant bleeding, low cardiac output syndrome, and arrhythmia in PICU, were assessed. Data are presented as frequencies and mean ± standard deviation.
  
  
  RESULTS
  A total of 82 patients were included. Mean age at time of operation was 7.25 ± 6.6 years. Fifty-three percent (n = 44) were <5 years old and 64% (n = 53) were men. Ventricular septal defect (47%, n = 39) was the most common lesion, followed by atrial septal defect (36%, n = 30), and tetralogy of Fallot (15%, n = 12), which were repaired. Cardiopulmonary bypass and aortic cross clamp time were 72.3 ± 34.2 and 47.3 ± 27.8 minutes, respectively. The mean inotrope score was 2.66 ± 3.53. There was no mortality in the cohort, whereas 97.8% (n = 80) had no complications during PICU stay. One patient (1.1%) required re-intubation for respiratory failure and one patient (1.1%) had arrhythmia that was medically managed. The mean length of PICU stay was 1.77 ± 0.985 days.
  
  
  CONCLUSIONS
  On-table extubation in children after open heart surgery was feasible and safe in selected group of patients. There was no major complication observed in the PICU.
authors.affiliation: Department of Pediatrics, Aga Khan University Hospital, Sindh, Pakistan.
authors.forename: Mehar
authors.initials: M
authors.lastname: Hoda
authors.affiliation: Department of Pediatrics, Aga Khan University Hospital, Sindh, Pakistan.
authors.forename: Anwarul
authors.initials: A
authors.lastname: Haque
authors.affiliation: Department of Pediatrics, Aga Khan University Hospital, Sindh, Pakistan.
authors.forename: Fareena
authors.initials: F
authors.lastname: Aijaz
authors.affiliation: Department of Anesthesia, Aga Khan University Hospital, Sindh, Pakistan.
authors.forename: Mohammad I
authors.initials: MI
authors.lastname: Akhtar
authors.affiliation: Department of Nursing, Aga Khan University Hospital, Sindh, Pakistan.
authors.forename: Amina
authors.initials: A
authors.lastname: Rehmat
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Sindh, Pakistan.
authors.forename: Muneer
authors.initials: M
authors.lastname: Amanullah
authors.affiliation: Department of Pediatrics, Aga Khan University Hospital, Sindh, Pakistan.
authors.forename: Babar S
authors.initials: BS
authors.lastname: Hasan
mesh_terms: D000293:Adolescent; D060666:Airway Extubation / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D010154:Pakistan; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac Surgery; Children; “On-table Extubation”