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Fast Track In Pediatric Cardiac Surgery

https://read.qxmd.com/read/33159866/right-axillary-thoracotomy-in-congenital-cardiac-surgery-analysis-of-percutaneous-cannulation
#21
JOURNAL ARTICLE
Paul Philipp Heinisch, Maris Bartkevics, Maria Julia Beck, Gabor Erdoes, Martin Glöckler, Tilman Humpl, Thierry Carrel, Alexander Kadner
BACKGROUND: Vertical right axillary mini-thoracotomy (VRAMT) represents a minimal-invasive and cosmetically attractive alternative for selected congenital heart defects. We report our institutional experience with VRAMT, especially regarding the performance of percutaneous femoral venous access to establish extracorporeal circulation in this pediatric population. METHODS: Retrospective single center analysis of children up to 16 years who underwent corrective cardiac surgery using VRAMT over a period of 5 years...
November 4, 2020: Annals of Thoracic Surgery
https://read.qxmd.com/read/32800620/preoperative-implementation-of-transverse-thoracic-muscle-plane-block-and-rectus-sheath-block-combination-for-pediatric-cardiac-surgery
#22
JOURNAL ARTICLE
Tomohiro Yamamoto, Yutaka Seino, Keiichiro Matsuda, Hidekazu Imai, Keiko Bamba, Ai Sugimoto, Shuichi Shiraishi, Ehrenfried Schindler
Systemic intravenous administration of opioids is the main treatment strategy for intraoperative and postoperative pain management in patients undergoing cardiac surgery with sternotomy. However, using lower doses of opioids may achieve the well-established benefits of the fast-track approach, with minimal opioid-related side effects. Postoperative pain is coupled with a long stay in the intensive care unit. Although neuraxial anesthesia has some benefits, its use remains controversial due to the potential development of epidural hematoma after anticoagulation for cardiopulmonary bypass and coagulopathy after cardiac surgery...
December 2020: Journal of Cardiothoracic and Vascular Anesthesia
https://read.qxmd.com/read/32294007/a-national-survey-current-clinical-practice-in-pediatric-anesthesia-for-congenital-heart-surgery
#23
MULTICENTER STUDY
Torsten Baehner, Nicholas Kiefer, Shahab Ghamari, Ingo Graeff, Christopher Huett, Stefan Pflugradt, Bjoern Sendzik, Ingo Heinze, Matthias Mueller, Ehrenfried Schindler, Georg Daniel Duerr, Richard Ellerkmann, Markus Velten
BACKGROUND: Providing anesthesia for pediatric patients undergoing congenital cardiac surgery is complex and requires profound knowledge and clinical experience. Prospective studies on best anesthetic management are missing, partially due to different standards. The aim of the present study was to survey the current standard practice in anesthetic management in pediatric cardiac surgical centers in Germany. METHODS: All 78 cardiac surgical centers in Germany were reviewed for a congenital cardiac surgery program...
May 2020: World Journal for Pediatric & Congenital Heart Surgery
https://read.qxmd.com/read/32030033/an-evolving-anesthetic-protocol-fosters-fast-tracking-in-pediatric-cardiac-surgery-a-comparison-of-two-anesthetic-techniques
#24
JOURNAL ARTICLE
Vipul K Sharma, Gaurav Kumar, Saajan Joshi, Nikhil Tiwari, Vivek Kumar, H Ravi Ramamurthy
BACKGROUND: The past two decades have seen rapid development of new surgical techniques for repair as well as palliation of complex congenital heart diseases. For a better patient outcome, minimal postoperative ventilation remains one of the most important endpoints of an effectual perioperative management. AIMS AND OBJECTIVES: The aim of this randomized open-label trial was to compare postoperative extubation time and intensive care unit (ICU) stay when two different anesthetic regimens, comprising of induction with ketamine and low-dose fentanyl versus high-dose fentanyl, are used, in pediatric patients undergoing corrective/palliative surgery...
January 2020: Annals of Pediatric Cardiology
https://read.qxmd.com/read/31143360/fast-track-extubation-in-paediatric-cardiothoracic-surgery-in-developing-countries
#25
Federica Iezzi, Michele Di Summa, Paolo Del Sarto, James Munene
In recent years, low-dose, short-acting anesthetic agents, which replaced the former high-dose opioid regimens, offer a faster postoperative recovery and decrease the need for mechanical ventilatory support. In this study, the aim was to determine the success rate of fast-track approach in surgical procedures for congenital heart disease. There is some evidence, mostly from retrospective analyses, that fast tracking can be beneficial. Ninety-one cases with moderate complex cardiac malformations were operated with fast-track protocol during cardiothoracic charitable missions...
2019: Pan African Medical Journal
https://read.qxmd.com/read/30115517/multicenter-international-survey-on-the-clinical-practice-of-ultra-fast-track-anesthesia-with-on-table-extubation-in-pediatric-congenital-cardiac-surgery
#26
MULTICENTER STUDY
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...
February 2019: Journal of Cardiothoracic and Vascular Anesthesia
https://read.qxmd.com/read/25849700/feasibility-and-safety-of-on-table-extubation-after-corrective-surgical-repair-of-tetralogy-of-fallot-in-a-developing-country-a-case-series
#27
JOURNAL ARTICLE
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
https://read.qxmd.com/read/25190943/safety-profile-of-fast-track-extubation-in-pediatric-congenital-heart-disease-surgery-patients-in-a-tertiary-care-hospital-of-a-developing-country-an-observational-prospective-study
#28
JOURNAL ARTICLE
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
https://read.qxmd.com/read/24492646/efficacy-of-evolving-early-extubation-strategy-on-early-postoperative-functional-recovery-in-pediatric-open-heart-surgery-a-matched-case-control-study
#29
JOURNAL ARTICLE
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
https://read.qxmd.com/read/23443672/economic-and-safety-implications-of-introducing-fast-tracking-in-congenital-heart-surgery
#30
COMPARATIVE STUDY
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
https://read.qxmd.com/read/23014834/fast-track-surgery-procedure-specific-aspects-and-future-direction
#31
REVIEW
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
https://read.qxmd.com/read/21342774/analgesia-in-fast-track-paediatric-cardiac-patients
#32
JOURNAL ARTICLE
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
https://read.qxmd.com/read/21122028/analgesia-and-sedation-after-pediatric-cardiac-surgery
#33
REVIEW
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
https://read.qxmd.com/read/20442538/fast-tracking-in-pediatric-cardiac-surgery-the-current-standing
#34
REVIEW
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
https://read.qxmd.com/read/19646888/fast-track-paediatric-cardiac-surgery-the-feasibility-and-benefits-of-a-protocol-for-uncomplicated-cases
#35
JOURNAL ARTICLE
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
https://read.qxmd.com/read/19348820/parental-perceptions-in-pediatric-cardiac-fast-track-surgery
#36
JOURNAL ARTICLE
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
https://read.qxmd.com/read/19261654/clinical-and-hemodynamic-factors-associated-with-the-outcome-of-early-extubation-attempts-after-right-heart-bypass-surgery
#37
COMPARATIVE STUDY
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
https://read.qxmd.com/read/17964455/real-time-tracking-and-shape-analysis-of-atrial-septal-defects-in-3d-echocardiography
#38
JOURNAL ARTICLE
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
https://read.qxmd.com/read/15242033/-bispectral-index-monitoring-in-fast-track-pediatric-cardiac-surgery
#39
JOURNAL ARTICLE
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
https://read.qxmd.com/read/15071874/-application-of-a-pde-iii-inhibitor-olprinone-for-fast-track-pediatric-cardiac-surgery
#40
JOURNAL ARTICLE
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
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