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Abstract
Objective: This study was designed to examine the effect of single shot of caudal neostigmine with bupivacaine on early extubation versus standard intravenous fentanyl regimen without caudal block. Design: Prospective, randomized double blind controlled clinical trial Setting of the study: Children University Hospital Patients: 80 children (4 to 12 years) undergoing correction of congenital heart defects Methods: Patients were randomized into two equal groups (caudal neostigmine group and non-caudal group); Anesthesia was provided with sevoflurane, midazolam, plus fentanyl 5 mcg/kg and cisatracurium 0.1 mg/kg and maintained with sevoflurane, fentanyl 1 mcg/kg/h. and cisatracurium 0.05 mg/kg. In caudal group; caudal block with bupivacaine (0.125%) in a dose of 1.5 ml/kg plus neostigmine in a dose of 2 mcg/kg was performed after endotracheal intubation in the caudal group only. In non-caudal group intravenous fentanyl was continuously infused postoperatively until weaning from mechanical ventilation. Measurements and Main Results: Both groups were comparable as regard age, sex, weight, and bypass and aortic cross clamp times. In the caudal neostigmine group patients were early extubated, with shorter Pediatric Intensive Care Unit (PICU) stay and prolonged postoperative analgesia. Eleven patients had nausea and vomiting in caudal versus four in non-caudal group. Conclusion: Single dose of caudal bupivacaine with neostigmine provided optimum conditions for extubation and good control of postoperative pain in children undergoing cardiac surgery.
Highlights
Weaning from mechanical ventilation in children undergoing repair of congenital cardiac disease was associated with improved cardiac performance and reduced incidence of postoperative pulmonary complications such as atelectasis [1].Fast-tracking in cardiac surgery refers to the concept of early extubation, mobilization and hospital discharge in an effort to reduce costs and perioperative morbidity [2,3].Fast-tracking for pediatric cardiac cases requires an anesthetic technique that allows safe early extubation either at the end of the procedure in the operative theater, or within a few hours in the Pediatric Intensive Care Unit (PICU) [4].A high-dose opioid technique is typically not used for this approach
This study was designed to examine the effect of single shot of caudal neostigmine with bupivacaine on early extubation versus standard intravenous fentanyl regimen without caudal block as a primary outcome
The sealed envelopes of randomization were opened early in the morning of surgery by the anesthetist who is going to give caudal block, and post-operative follow up of this patients were done by ICU doctors who were unaware by the type of randomization
Summary
Weaning from mechanical ventilation in children undergoing repair of congenital cardiac disease was associated with improved cardiac performance and reduced incidence of postoperative pulmonary complications such as atelectasis [1].Fast-tracking in cardiac surgery refers to the concept of early extubation, mobilization and hospital discharge in an effort to reduce costs and perioperative morbidity [2,3].Fast-tracking for pediatric cardiac cases requires an anesthetic technique that allows safe early extubation either at the end of the procedure in the operative theater, or within a few hours in the Pediatric Intensive Care Unit (PICU) [4].A high-dose opioid technique is typically not used for this approach. Fast-tracking in cardiac surgery refers to the concept of early extubation, mobilization and hospital discharge in an effort to reduce costs and perioperative morbidity [2,3]. Fast-tracking for pediatric cardiac cases requires an anesthetic technique that allows safe early extubation either at the end of the procedure in the operative theater, or within a few hours in the Pediatric Intensive Care Unit (PICU) [4]. A high-dose opioid technique is typically not used for this approach. Neuraxial techniques have been used to minimize the use of intravenous opioid administration and to improve post operative outcome in a fast-track protocol. There is major controversy about the safety, and benefits (outcome measures) of such approaches [5,6]
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