Benefits of ultra-fast-track anesthesia for children with congenital heart disease undergoing cardiac surgery

Jing Xu,Na Li,Guanghua Zhou,Yanpei Li

doi:10.1186/s12887-019-1832-9

Jing Xu, Na Li + Show 2 more

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https://doi.org/10.1186/s12887-019-1832-9

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Journal: BMC Pediatrics	Publication Date: Dec 1, 2019
Citations: 19	License type: open-access

Affiliation: Beijing Emergency Medical Center

Abstract

BackgroundTo compare the outcomes of ultra-fast-track anesthesia (UFTA) and conventional anesthesia in cardiac surgery for children with congenital heart disease (CHD) and low birth weight.MethodsOne hundred and ninety-four CHD children, aged 6 months to 2 years, weighting 5 to 10 kg, were selected for this study. The 94 boys and 100 girls with the American Society of Anesthesiologists (ASA) physical status III and IV were randomly divided into two groups each consisting of 97 patients, and were subjected to ultra-fast-track and conventional anesthesia for cardiac surgery. For children in UFTA group, sevoflurane was stopped when cardiopulmonary bypass (CPB) started and cis-atracurium was stopped at the beginning of rewarming, and remifentanil (0.3 μg/kg/mim) was then infused. Propofol and remifentanil were discontinued at skin closure. 10 min after surgery, extubation was performed in operating room. For children in conventional anesthesia group, anesthesia was given routinely and they were directly sent to ICU with a tracheal tube. Extubation time, ICU stay and hospital stay after operation were recorded. Sedation-agitation scores (SAS) were assessed and adverse reactions as well as other anesthesia –related events were recorded.ResultsThe extubation time, ICU stay and hospital stay were significantly shorter in UFTA group (P < 0.05) and SAS at extubation was lower in UFTA group than in conventional anesthesia group, but similar in other time points. For both groups, no airway obstruction and other serious complications occurred, and incidence of other anesthesia –related events were low.ConclusionsUFTA shortens extubation time, ICU stay and hospital stay for children with CHD and does not increase SAS and incidence of adverse reactions.

Highlights

To compare the outcomes of ultra-fast-track anesthesia (UFTA) and conventional anesthesia in cardiac surgery for children with congenital heart disease (CHD) and low birth weight
We aimed to investigate the outcomes of UFTA in CHD children in cardiac surgery and to assess the effect of UFTA in reducing postoperative complication
Two groups of patients had no difference in gender, age, body weight, CHA classification, American Society of Anesthesiologists (ASA) grade, surgical methods, anesthesia time, cardiopulmonary bypass (CPB) time and block time (Table 1)

Summary

Introduction

To compare the outcomes of ultra-fast-track anesthesia (UFTA) and conventional anesthesia in cardiac surgery for children with congenital heart disease (CHD) and low birth weight. Fast-track anesthesia (FTA) is a procedure that enables extubation in intensive care unit (ICU) within 6 h after surgery to facilitate the recovery of consciousness and autonomous breathing. FTA is feasible and safe and reduces the occurrence of ventilatorinduced complications, thereby decreasing ICU stay, resource use and cost [3,4,5]. Ultra-fast tract anesthesia (UFTA) was developed after fast-track anesthesia to further optimize the use of medical resource. With UFTA, Congenital heart disease (CHD) is the most common type of congenital anomaly, occurring in up to 1% of all live births. Anesthesia procedures are ideal for medical and cardiac surgical management. The risks of the procedures include cardiovascular and respiratory complications from anesthesia and sedation and a potentially underappreciated risk of neurocognitive dysfunction [14] and improvement in anesthesia management would

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