title: Five-year experience with immediate extubation after arterial switch operations for transposition of great arteries.
abstract: We sought to identify preoperative, intraoperative and anatomical factors associated with immediate extubation (IE) after arterial switch operation for d-transposition of great arteries (dTGA).
  
  
  
  This was a single-centre retrospective study performed from 1 January 2010 to 30 June 2015. IE was defined as successful extubation in the operating room (OR). Univariate/bivariate regression of preoperative, intraoperative and anatomical variables was used to determine associations with IE.
  
  
  
  Of 32 patients in the dTGA spectrum (age at operation 6 days), 18 (56%) underwent IE. Twelve (71%) of the 17 patients with an intact ventricular septum and 6 (43%) of the 14 patients with ventricular septal defect (VSD) underwent IE, whereas none of the patients with double outlet right ventricle or aortic arch obstruction ( n  = 4) did. Patients who had cardiopulmonary bypass time (CPB) >173 min ( P  = 0.01), lowest temperature on CPB (T min) ≤ 30.4°C ( P  = 0.04) and aortic cross-clamp time >86 min ( P  = 0.04) were more likely to be left intubated at the end of the procedure. There was no significant difference in patient's chronological age, gestational age, post-conceptual age, weight, coronary anatomy or prevalence of VSD between those who did and did not undergo IE. There was a median increase in intensive care unit (ICU) length of stay (LOS) by 1 day (33%, P  = 0.03) and ICU costs by $12 338 (15%, P  = 0.06) in non-IE patients. The OR turnover time ( P  = 0.09) and reintubation rate ( P  = 1) at 24 h post-extubation did not differ between those who did and did not have IE. There was no myocardial dysfunction evident on predismissal echocardiography in either group.
  
  
  
  In this cohort of infants, post repair for TGA, 56% were extubated immediately in the OR. Greater CPB and cross-clamp times and T min ≤ 30.4°C were associated with a lesser likelihood of IE. IE was associated with shorter ICU length of stay.
authors.affiliation: Department of Pediatric Anesthesia, Children's Hospital and Medical Center, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA.
authors.forename: Joby
authors.initials: J
authors.lastname: Varghese
authors.affiliation: Department of Pediatric Anesthesia, Children's Hospital and Medical Center, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA.
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
authors.affiliation: Department of Pediatric Anesthesia, Children's Hospital and Medical Center, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA.
authors.forename: Karl Stessy
authors.initials: KS
authors.lastname: Bisselou Moukagna
authors.affiliation: Department of Pediatric Anesthesia, Children's Hospital and Medical Center, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Craft
authors.affiliation: Department of Pediatric Anesthesia, Children's Hospital and Medical Center, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abdullah
authors.affiliation: Department of Pediatric Anesthesia, Children's Hospital and Medical Center, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Hammel
mesh_terms: D060666:Airway Extubation / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D000069278:Arterial Switch Operation / Q000379:methods*; D003422:Critical Care; D006345:Heart Septal Defects, Ventricular / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Congenital heart disease; Immediate extubation; Neonatal cardiac surgery; Paediatric cardiology; Transposition of great arteries