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Fast Track In Pediatric Cardiac Surgery

Mohammad Irfan Akhtar, Mona Momeni, Andrea Szekely, Mohammad Hamid, Mohamed R El Tahan, Steffen Rex
OBJECTIVE: To describe global practices for on-table extubation (OTE) in pediatric cardiac anesthesia in European and non-European countries. DESIGN: Multiple-choice, web-based survey with 34 questions addressing organizational data, existence of OTE programs, inclusion and exclusion criteria for OTE, and intraoperative and immediate postoperative management. SETTING: Online survey endorsed by the European Association of Cardiothoracic Anesthesiologists...
July 7, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai, Naveed Rehman
Fast-track extubation is an established safe practice in pediatric congenital heart disease (CHD) surgical patients. On table extubation (OTE) in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF) cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post-TOF repair complications such as low cardiac output state and arrhythmias...
April 2015: Annals of Cardiac Anaesthesia
Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai, Amina Rehmat Wali, Anwar-Ul-Haq, Muneer Aman-Ullah, Khalid Ahsan
BACKGROUND AND AIMS: 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. MATERIALS AND 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...
July 2014: Journal of Anaesthesiology, Clinical Pharmacology
Barbara C S Hamilton, Osami Honjo, Abdullah A Alghamdi, Christopher A Caldarone, Steven M Schwartz, Glen S Van Arsdell, Helen Holtby
There has been a paradigm shift toward "fast-track" management with early extubation (EE) in cardiac surgery. Our retrospective, matched case-control study wishes to define the benefits of EE in pediatric congenital heart surgery. We examined 50 consecutive pediatric cardiac surgery patients extubated in the operating room (February 2009 to July 2009) against a control group of delayed-extubation patients. No significant differences were found in preoperative variables except heart failure medication. Significant intraoperative variables included the following: blood products (363 vs 487 mL, P = ...
September 2014: Seminars in Cardiothoracic and Vascular Anesthesia
Emily J Lawrence, Khanh Nguyen, Shaine A Morris, Ingrid Hollinger, Dionne A Graham, Kathy J Jenkins, Carol Bodian, Hung-Mo Lin, Bruce D Gelb, Alexander J C Mittnacht
BACKGROUND: The feasibility of fast-tracking children undergoing congenital heart disease surgery has not been assessed adequately. Current knowledge is based on limited single-center experiences without contemporaneous control groups. METHODS AND RESULTS: We compared administrative data for atrial septal defect (ASD) and ventricular septal defect (VSD) surgeries in children 2 months to 19 years of age at the Mount Sinai Medical Center (MSMC) with data from comparable patients at 40 centers contributing to the Pediatric Health Information System...
March 1, 2013: Circulation. Cardiovascular Quality and Outcomes
Daniel Ansari, Luca Gianotti, Jörg Schröder, Roland Andersson
INTRODUCTION: Fast-track (FT) surgery can be defined as a coordinated perioperative approach aimed at reducing surgical stress and facilitating postoperative recovery. The objective of this review was to examine the literature on the procedure-specific application of FT surgery. DISCUSSION: The concept of FT rehabilitation has been applied mainly in colorectal surgery, but positive data have appeared also in other areas such as orthopedic, hepatopancreaticobiliary, urological, upper gastrointestinal, gynecological, thoracic, vascular, endocrine, breast, and pediatric surgeries...
January 2013: Langenbeck's Archives of Surgery
Francesca G Iodice, Mark Thomas, Isabeau Walker, Vanessa Garside, Martin J Elliott
OBJECTIVE: We introduced a fast-track program for our cardiac operations requiring adjustment in anaesthesia techniques to facilitate rapid extubation and discharge from the intensive care unit (ICU). Our objective was to investigate the quality of analgesia in fast-track paediatric cardiac patients. METHODS: We performed a retrospective review of the records of all patients who were fast-tracked in our institution between January 2006 and January 2007. Data collected included surgical procedure, anaesthesia technique, intra-operative opioids, ventilation time, intensive care stay, postoperative morphine consumption, pain scores, patient-controlled analgesia/nurse-controlled analgesia (PCA/NCA) duration, supplemental analgesia and incidence of vomiting...
September 2011: European Journal of Cardio-thoracic Surgery
Andrew R Wolf, Lara Jackman
In recent years, the importance of appropriate intra-operative anesthesia and analgesia during cardiac surgery has become recognized as a factor in postoperative recovery. This includes the early perioperative management of the neonate undergoing radical surgery and more recently the care surrounding fast-track and ultra fast-track surgery. However, outside these areas, relatively little attention has focused on postoperative sedation and analgesia within the pediatric intensive care unit (PICU). This reflects perceived priorities of the primary disease process over the supporting structure of PICU, with a generic approach to sedation and analgesia that can result in additional morbidities and delayed recovery...
May 2011: Paediatric Anaesthesia
Alexander J C Mittnacht, Ingrid Hollinger
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. With careful patient selection, fast-tracking can be performed in many patients undergoing surgery for congenital heart disease (CHD). In order to accomplish this safely, a multidisciplinary coordinated approach is necessary. This manuscript reviews currently used anesthetic techniques, patient selection, and available information about the safety and patient outcome associated with this approach...
May 2010: Annals of Cardiac Anaesthesia
Felicity Howard, Kate L Brown, Vanessa Garside, Isabeau Walker, Martin J Elliott
OBJECTIVE: Fast-track patient pathways for cardiac surgery are used in adult practice and by necessity is a mainstay in the developing world. We aimed to introduce a fast-track protocol for uncomplicated paediatric open-heart surgery cases and to subsequently review the results of this change in practice. METHODS: A fast-track protocol co-ordinated by the Advanced Nurse Practitioners was introduced in January 2006 for children aged over 6 months undergoing uncomplicated open-heart procedures...
January 2010: European Journal of Cardio-thoracic Surgery
Kaanthan Jawahar, Angela Antonia Scarisbrick
This project investigated parents' and caregivers' perceptions of the fast-track surgery process with regard to their child's surgical procedure and hospital stay. The goal of this project was to review and improve the fast-track process. Participants were parents/caregivers of pediatric patients (ie, younger than 18 years) who had undergone a low-complexity cardiac surgical procedure on a fast-track basis at Great Ormond Street Hospital for Children, London, United Kingdom, between January 2006 and January 2008...
April 2009: AORN Journal
Yuka Kurihara, Nobuaki Shime, Takako Miyazaki, Satoru Hashimoto, Yoshifumi Tanaka
Fast-track anesthesia with early extubation (EE) is playing an increasingly important role in pediatric cardiac surgery. We examined the pre- and intra-operative factors contributing to successful EE, and outcomes after right heart bypass surgery (RHB). We retrospectively reviewed the medical records of 71 consecutive children (median age=14 months) admitted over a 4-year period to the pediatric intensive care unit (PICU) of our university-based hospital, after RHB. We compared the characteristics and outcomes of 38 children (54%) extubated <3 h, with those of 33 (46%) extubated >or=3 h after surgery...
June 2009: Interactive Cardiovascular and Thoracic Surgery
Marius George Linguraru, Alexandre Kabla, Gerald R Marx, Pedro J del Nido, Robert D Howe
RATIONALE AND OBJECTIVES: Real-time cardiac ultrasound (US) allows monitoring the heart motion during intracardiac beating heart procedures. Our application assists pediatric atrial septal defect (ASD) closure techniques using real-time 3D US guidance and rigid instruments. ASD tracking is also an important tool for facilitating systematic clinical studies of the dynamic behavior of the intra-atrial communication. One major image processing challenge is associated with the required processing of information at high frame rate, especially given the low image quality...
November 2007: Academic Radiology
Miyuki Maruyama, Hirotsugu Okamoto, Junko Suwa, Toshihide Asou, Sumio Hoka
BACKGROUND: We evaluated the changes in the bispectral index (BIS) as a potential indicator of level of consciousness in infants and children undergoing fast track cardiac surgery. METHODS: Twenty-one children undergoing fast track cardiac surgery were recruited into this study. Anesthesia was maintained with inhaled sevoflurane and intravenous fentanyl 10 microg x kg(-1). Cardiopulmonary bypass (CPB) with mild hypothermia and an immediate tracheal extubation protocol were used...
June 2004: Masui. the Japanese Journal of Anesthesiology
Miyuki Itou, Hirotsugu Okamoto, Junko Suwa, Toshihide Asou, Sumio Hoka
BACKGROUND: We examined the effects of olprinone (OLP), a PDE III inhibitor, on the time to extubation and on the hemodynamics in infants and children undergoing fast track cardiac surgery. METHODS: Nineteen consecutive children undergoing fast track cardiac surgery were recruited in this study. In the first five children, chlorpromazine (CPZ) was administered conventionally for the purpose of vasodilation during the cardiac surgery (CPZ group). In the latter fourteen children, OLP (50 micrograms...
March 2004: Masui. the Japanese Journal of Anesthesiology
Ismail A Sallam
The pathologic patterns as an indication for cardiac surgery in adults with congenital heart diseases and subsequently the surgical techniques have changed greatly in the last decade. The presence of fully equipped pediatric cardiac units helped in early surgical repair in many lesions. However, this service is not always readily available in many parts of the world with the effect of seeing patients with congenital heart diseases latter on during their life needing intervention. Also, older surgical concepts (like considering a trileaflet mitral valve as normal) resulted in the presentation of a subgroup of patients who needed re-intervention latter during adulthood...
October 2002: Seminars in Thoracic and Cardiovascular Surgery
Bruce E Miller, Kathy K Spitzer
As the fields of pediatric cardiology and cardiac surgery advance in complexity and in accountability for clinical and economic outcomes, several issues traditionally associated with the operating room are becoming important to physicians, nurses, and respiratory therapists who take care of children after cardiac surgery. The article discusses the concepts of "fast track" cardiac surgery, regional anesthetic techniques, coagulopathies and bleeding after cardiopulmonary bypass, intraoperative ultrafiltration, and mechanical circulatory assist devices...
November 2002: Critical Care Nursing Quarterly
Chris Aps
Dr Chris Aps has been involved, since the early 1980s, with the impact of the surgical patient on critical care provision. At that time, he established clinical techniques to lower patient dependency after cardiac surgery. This allowed for the postoperative management of such patients in a general recovery facility rather than in the formal Intensive Care Unit (ICU). This became known as cardiac fast-tracking and led to the development of the Overnight Intensive Recovery (OIR) concept.
July 2002: British Journal of Perioperative Nursing: the Journal of the National Association of Theatre Nurses
L S Shekerdemian, D J Penny, W Novick
In recent years, post-operative intensive care of the child with congenital cardiac disease has placed an emphasis on earlier weaning from mechanical ventilation. We describe our experience of postoperative fast-tracking of children undergoing cardiac surgery during a charitable mission in Venezuela, where resources and equipment were severely limited. During our stay, 11 children, with a median age of 2 years, underwent total correction of tetralogy of Fallot. The median duration of ventilation was 2.5 hours, and all patients were extubated within 12 hours of surgery...
November 2000: Cardiology in the Young
L A Vricella, J A Dearani, S R Gundry, A J Razzouk, S D Brauer, L L Bailey
BACKGROUND: Changes in healthcare delivery have affected the practice of congenital cardiac surgery. We recently developed a strategy of limited sternotomy, early extubation, and very early discharge, and reviewed the perioperative course of 198 pediatric patients undergoing elective cardiovascular surgical procedures, to assess the efficacy and safety of this approach. METHODS: One hundred ninety-eight patients aged 0 to 18 years (median 3.2 years) underwent 201 elective cardiovascular surgical procedures over a 1-year period...
March 2000: Annals of Thoracic Surgery
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