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Clinical and hemodynamic factors associated with the outcome of early extubation attempts after right heart bypass surgery

^a Department of Anesthesiology and Intensive Care, School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
^b Department of Pediatric Cardiac Surgery, School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

*Corresponding author. Associate Professor, Intensive Care Division, Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo-ku, Kyoto 602-8566, Japan. Tel.: +81-75-251-5633; fax: +81-75-251-5843.

E-mail address: shime{at}koto.kpu-m.ac.jp (N. Shime).

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 3 h after surgery. Odd ratios (OR) and 95% confidence intervals (CI) were calculated. Variables associated with EE included a lower dose of intra-operative fentanyl (OR: 0.95; 95% CI, 0.92–0.99; P=0.03), nitroglycerin (OR: 0.23; 95% CI, 0.07–0.73; P=0.01), and a lower inotropic score (OR: 0.76; 95% CI, 0.61–0.94; P=0.01) on admission. EE was correlated with fewer postoperative respiratory complications (OR: 0.09; 95% CI, 0.02–0.57; P=0.01) and shorter stay in the PICU (OR: 0.88; 95% CI, 0.76–1.03; P=0.12). Our data suggest that EE after RHB could be facilitated in patients with a preserved cardiac function and lower pulmonary vascular resistance. EE could be followed by fewer postoperative pulmonary complications.

Key Words: Early extubation; Fontan operation; Right heart bypass surgery; Postoperative complications