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Özçobanoğlu S, Gündüz E, Tekerek NÜ. Comparison of ultrafast and fast track extubation after secundum atrial septal defect surgery in pediatric age group. Acta Chir Belg 2024; 124:217-222. [PMID: 37937527 DOI: 10.1080/00015458.2023.2281097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023]
Abstract
BACGROUND Patients who underwent ultrafast track on the operating table and fast track extubation in the pediatric intensive care unit for 2 to 6 h after secundum atrial septal defect surgery in the pediatric age group were compared. METHODS Between January 2013 and February 2017, 60 pediatric patients (24 boys, 36 girls; Mean age 7.5 ± 4.6 years) whose secundum atrial defect was closed were retrospectively analyzed. The patients were separated as those who were extubated on the operating table (Group1,n = 28) and those extubated in the pediatric intensive care unit within 2-6 h postoperatively (Group2,n = 32). RESULTS No difference was found in demographic data and preoperative catheter information between the groups. Cardiopulmonary bypass time was 20(18-25)/27.5(20-30)minutes (p:0.001), the cross-clamp time was 10(10-15)/15(11-20)minutes(p:0.004), the postoperative drainage amount was 50(25-50)/60(32.5-100)ml(p:0.013), the length of stay in the intensive care unit was 1(1--1)/1(1-2)day(p:0.025), the length of stay after intensive care was 3(2-3)/3(3-4)days(p:0.001) and the total hospital stay was 4(3-4)/5(4-5.5) days (p < 0.001), which were respectively shorter for the group 1 compared to 2. Postoperative blood product replacement, positive inotrope support, pericardial effusion, mortality, and morbidity were not detected in either groups. CONCLUSION In this study, it was observed that the UFT extubation was safe for the patients who were operated for secundum ASD, in the pediatric age group, and had a cross-clamp time not exceeding 15 min. It was found that the amount of drainage, length of stay in the intensive care unit, post-intensive care unit, and the total hospital stay of patients extubated on the operating table were shorter.
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Affiliation(s)
- Salih Özçobanoğlu
- Department of Cardiovascular Surgery, Akdeniz University, Antalya, Turkey
| | - Emel Gündüz
- Department of Anesthesiology and Reanimation, Akdeniz University, Antalya, Turkey
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Kim CH, Lee JH, Kwon HW, Cho S, Kim WH, Ji SH, Jang YE, Kim JT, Kwak JG. Extubation in operating room versus early extubation in ICU after open-heart surgery in patients with CHDs. Cardiol Young 2024; 34:914-918. [PMID: 37981864 DOI: 10.1017/s1047951123003839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUNDS AND OBJECTIVES The "Fast track" protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD. METHODS We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled "Fast track" protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays. RESULTS The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0-169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031). CONCLUSIONS Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.
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Affiliation(s)
- Chan Hyeong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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3
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Fan S, Liu H, Zhu Y, Zheng Z, Cui Q. Effect of fast-track surgery on postoperative wound pain in patients with prostate cancer: A meta-analysis. Int Wound J 2023; 21:e14417. [PMID: 37737032 PMCID: PMC10824699 DOI: 10.1111/iwj.14417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
Fast track surgery (FTS) is widely used in many procedures and has been shown to reduce complications and accelerate recovery. However, no studies have been conducted to assess their effectiveness in treating wounds after radical prostatectomy (RP). The objective of this study was to evaluate the impact of FTS on RP. We went through 4 major databases. A study was conducted by PubMed, the Cochrane Library, Embase, and the Web of Science to determine the effect of comparison of FTS versus conventional surgery in RP on postoperative wound complications as of 1 July 2023. Based on the review of literature, data extraction and literature quality assessment, we conducted meta-analyses with RevMan 5.3. In the course of the study, the researchers selected 6 of the 404 studies to be analysed according to exclusion criteria. Data analysis showed that the FTS method reduced the postoperative pain associated with VAS and also decreased the rate of postoperative complications in post-surgical patients. However, there was no significant difference between FTS and conventional surgery in terms of blood loss, operation time, and postoperative infection rate. Therefore, generally speaking, FTS has less impact on postoperative complications in patients with minimal invasive prostatic cancer, but it does reduce postoperative pain and total postoperative complications.
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Affiliation(s)
- Shicheng Fan
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
| | - Haolin Liu
- Department of UrologyInstitute of Urology, West China Hospital, Sichuan UniversityChengduChina
| | - Yuanquan Zhu
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
| | - Zhiqiang Zheng
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
| | - Qingpeng Cui
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
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Altun D, Arnaz A, Doğan A, Yalçinbaş Y, Türköz R, Oktay A, Yüksek A, Altun D, Sarıoğlu T. A retrospective analysis of dexmedetomidine and morphine in the fast-track and ultra-fast-track extubation protocol after congenital cardiac surgery. J Card Surg 2022; 37:4234-4242. [PMID: 35880442 DOI: 10.1111/jocs.16709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY After congenital cardiac surgery, the duration of mechanical ventilation (MV) is related to the clinical status, type of operation, and the sedative-analgesic agents used postoperatively. This study aims to examine the effects of dexmedetomidine and morphine on the fast-track extubation (FTE) and ultra-fast-track extubation (UFTE) protocol after congenital cardiac surgery. METHODS A total of 251 pediatric patients were divided into two groups: 118 patients in the morphine group (Group M) and 133 patients in the dexmedetomidine group (Group D). We retrospectively reviewed medical data including hemodynamic parameters, duration of MV and cardiovascular intensive care unit (CICU), additional sedative/analgesic requirement, adverse events, the need for reintubation, and noninvasive MV, sedation, and pain scores. RESULTS The mean mechanical ventilation duration of Group D was significantly shorter than Group M (3.74 ± 0.83 h in Group D, 5.72 ± 1.54 h in Group M, respectively) (p = .001; p < .05). In Group D, the success rate of FTE was 92.5% (n = 123) and UFTE was 7.5% (n = 10) (p = .001). In Group M, the success rate of FTE was 72.9% (n = 86) and UFTE was 0% (n = 0) (p > .05). CONCLUSIONS Dexmedetomidine and morphine have clinical benefits which encourage their use for FTE protocol. Dexmedetomidine has more benefits compared to morphine. It can be used in UFTE protocol, besides its use in FTE protocol with fewer side effects.
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Affiliation(s)
- Dilek Altun
- Department of Anesthesiology and Reanimation, Vocational School of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Ahmet Arnaz
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Abdullah Doğan
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Yusuf Yalçinbaş
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Rıza Türköz
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ayla Oktay
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Adnan Yüksek
- Department of Anesthesiology and Reanimation, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Demet Altun
- Department of Anesthesiology and Reanimation, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Tayyar Sarıoğlu
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
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Anesthetic Management in Adults with Congenital Heart Disease. Curr Cardiol Rep 2022; 24:235-246. [PMID: 35080704 DOI: 10.1007/s11886-022-01639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Adults with congenital heart disease (ACHD) are a complex and growing population that presents numerous challenges for anesthetic management. This review summarizes special considerations for anesthetic management in ACHD. RECENT FINDINGS The adult patient with congenital heart disease may require anesthetic care for multiple surgeries and interventions throughout their lifetime. The cardiac and extracardiac manifestations of ACHD have important perioperative implications that affect anesthetic management. Recent American Heart Association/American College of Cardiology and European Society of Cardiology guidelines endorse a multidisciplinary, team-based approach to care. The cardiac anesthesiologist, endorsed as part of this multidisciplinary team, must have a thorough understanding of congenital heart disease pathophysiology and common extra-cardiac manifestations of ACHD. Safe anesthetic management in adult congenital heart disease should incorporate a multi-disciplinary approach to patient care. Anesthesiologists and centers with special expertise in ACHD care should be utilized or consulted whenever possible.
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Xing J, Wang J, Liu G, Jia Y. Effects of enhanced recovery after surgery on robotic radical prostatectomy: a systematic review and meta-analysis. Gland Surg 2021; 10:3264-3271. [PMID: 35070886 PMCID: PMC8749100 DOI: 10.21037/gs-21-699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/04/2021] [Indexed: 04/06/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) has been shown to be an effective, reliable and practical clinical nursing method to support operations on a range of physiological systems, but its effects on robotic radical prostatectomy (RRP) are still unclear. This study assesses the clinical effects of ERAS in RRP. METHODS Various databases including PubMed, EMBASE, Web of Science and China National Knowledge were searched for relevant studies, in particular full-text articles comparing ERAS groups and conventional groups for RRP. All included articles were subject to a quality assessment, and the data analysis was conducted with Review Manager (5.3). Forest plots, sensitivity analyses, and bias analyses were also prepared based on the included articles. RESULTS In total, 8 studies were identified that met the inclusion criteria. The results showed that ERAS groups exhibited significantly reduced time of flatus [mean difference (MD) =-0.58; 95% confidence interval (CI): -0.88, -0.29; P=0.0001], time of catheter removal (MD =-1.65; 95% CI: -2.15, -1.16; P<0.00001), and length of stay (LOS) (MD =-1.49; 95% CI: -2.65, -0.34; P=0.01), and there was no significant difference in terms of postoperative complications between ERAS groups and conventional groups (P=0.07). DISCUSSION This study provides further evidence that ERAS improves postoperative recovery in patients undergoing RRP through reduced time of first flatus, time of catheter removal and LOS. Given the limited quality and quantity of the articles included in this study, further work is needed to validate these findings.
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Affiliation(s)
- Jiahui Xing
- Urology Department, Peking Union Medical College Hospital, Chinese Medical College of Medicine, Beijing, China
| | - Juan Wang
- Urology Department, Peking Union Medical College Hospital, Chinese Medical College of Medicine, Beijing, China
| | - Guanghua Liu
- Urology Department, Peking Union Medical College Hospital, Chinese Medical College of Medicine, Beijing, China
| | - Yujie Jia
- Urology Department, Peking Union Medical College Hospital, Chinese Medical College of Medicine, Beijing, China
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Bianchi P, Constantine A, Costola G, Mele S, Shore D, Dimopoulos K, Aw T. Ultra-Fast-Track Extubation in Adult Congenital Heart Surgery. J Am Heart Assoc 2021; 10:e020201. [PMID: 33998289 PMCID: PMC8483528 DOI: 10.1161/jaha.120.020201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
Background In pediatric cardiac surgery, perioperative management has evolved from slow weaning of mechanical ventilation in the intensive care unit to "ultra-fast-track" anesthesia with early extubation (EE) in theater to promote a faster recovery. The strategy of EE has not been assessed in adults with congenital heart disease, a growing population of patients who often require surgery. Methods And Results Data were collected retrospectively on all patients >16 years of age who underwent adult congenital heart surgery in our tertiary center between December 2012 and January 2020. Coarsened exact matching was performed for relevant baseline variables. Overall, 711 procedures were performed: 133 (18.7%) patients underwent EE and 578 (81.3%) patients received conventional extubation. After matching, patients who received EE required less inotropic or vasopressor support in the early postoperative period (median Vasoactive-inotropic score 0.5 [0.0-2.0] versus 2.0 [0.0-3.5]; P<0.0001) and had a lower total net fluid balance than patients after conventional extubation (1168±723 versus 847±733 mL; P=0.0002). The overall reintubation rate was low at 0.3%. EE was associated with a significantly shorter postoperative length of stay in higher dependency care units before a "step-down" to ward-based care (48 [45-50] versus 50 [47-69] hours; P=0.004). Lower combined intensive care unit and high dependency unit costs were incurred by patients who received EE compared with patients who received conventional extubation (£3949 [3430-4222] versus £4166 [3893-5603]; P<0.0001). Conclusions In adult patients undergoing surgery for congenital heart disease, EE is associated with a reduced need for postoperative hemodynamic support, a shorter intensive care unit stay, and lower health-care-related costs.
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Affiliation(s)
- Paolo Bianchi
- Department of Anaesthesia and Intensive CareRoyal Brompton HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
- Division of Anaesthetics, Pain Medicine and Intensive CareDepartment of Surgery and CancerImperial College LondonLondonUnited Kingdom
| | - Andrew Constantine
- Adult Congenital Heart Centre and National Centre for Pulmonary HypertensionRoyal Brompton HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
| | - Giulia Costola
- Adult Congenital Heart Centre and National Centre for Pulmonary HypertensionRoyal Brompton HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - Sara Mele
- Department of Anaesthesia and Intensive CareRoyal Brompton HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - Darryl Shore
- Adult Congenital Heart Centre and National Centre for Pulmonary HypertensionRoyal Brompton HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary HypertensionRoyal Brompton HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
| | - Tuan‐Chen Aw
- Department of Anaesthesia and Intensive CareRoyal Brompton HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonUnited Kingdom
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Fuller S, Kumar SR, Roy N, Mahle WT, Romano JC, Nelson JS, Hammel JM, Imamura M, Zhang H, Fremes SE, McHugh-Grant S, Nicolson SC. The American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group 2021 consensus document on a comprehensive perioperative approach to enhanced recovery after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2021; 162:931-954. [PMID: 34059337 DOI: 10.1016/j.jtcvs.2021.04.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Stephanie Fuller
- Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - S Ram Kumar
- Division of Cardiac Surgery, Department of Surgery, and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Heart Institute, Children's Hospital Los Angeles, Los Angeles, Calif.
| | - Nathalie Roy
- Department of Cardiac Surgery, Boston Children's Hospital, Department of Surgery, Harvard Medical School, Boston, Mass
| | - William T Mahle
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Jennifer C Romano
- Departments of Cardiac Surgery and Pediatrics, University of Michigan, CS Mott Children's Hospital, Ann Arbor, Mich
| | - Jennifer S Nelson
- Department of Cardiovascular Services, Nemours Children's Hospital, and Department of Surgery, University of Central Florida College of Medicine, Orlando, Fla
| | - James M Hammel
- Department of Cardiothoracic Surgery, Children's Hospital and Medical Center of Omaha, Omaha, Neb
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sara McHugh-Grant
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Susan C Nicolson
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Penn
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Li L, Jiang Y, Zhang W. Sugammadex for Fast-Track Surgery in Children Undergoing Cardiac Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2020; 35:1388-1392. [PMID: 32962936 DOI: 10.1053/j.jvca.2020.08.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/17/2020] [Accepted: 08/31/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of sugammadex for fast-track surgery in children undergoing cardiac surgery. DESIGN This was a prospective, randomized, controlled clinical study. SETTING University hospital. PARTICIPANTS The study comprised 60 children undergoing cardiac surgery. INTERVENTIONS The children in group S received sugammadex, 4 mg/kg, for reversal of neuromuscular block, and the children in group N received neostigmine, 30 µg/kg, and atropine, 15 µg/kg. MEASUREMENTS AND MAIN RESULTS The recovery time to a train-of-four of 0.9 and extubation time were significantly shorter in the group S than in group N (3.4 ± 1.2 min v 76.2 ± 20.5 min and 31.0 ± 6.4 min v 125.2 ± 21.6 min, respectively; p < 0.01). The heart rate after drug administration was higher in group S than in group N (102.7 ± 9.4 beats/min v 96.9 ± 8.5 beats/min; p = 0.03), whereas the mean arterial pressure after drug administration was similar in both groups. The length of hospital stay was shorter in group S (5.8 ± 1.0 v 6.5 ± 0.9 days; p = 0.03), and the hospitalization expenses were decreased in group S compared with that of group N ($1,036 ± $114 v $1,286 ± $187; p < 0.01). The incidence of postoperative atelectasis was less in group S than in group N (0 v 20%; p = 0.024). CONCLUSION Sugammadex can shorten the extubation time and reduce the incidence of postoperative atelectasis, with fewer adverse events, in children undergoing cardiac surgery. It may be beneficial to use sugammadex for fast-track surgery in children undergoing cardiac surgery.
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Affiliation(s)
- L Li
- Department of Anesthesiology, Wenzhou Central Hospital, Wenzhou, China
| | - Y Jiang
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - W Zhang
- Department of Anesthesiology, Women and Children's Hospital of Jiaxing University, Jiaxing, China.
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Effects of sugammadex on postoperative respiratory management in children with congenital heart disease: a randomized controlled study. Biomed Pharmacother 2020; 127:110180. [PMID: 32353822 DOI: 10.1016/j.biopha.2020.110180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/07/2020] [Accepted: 04/17/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early extubation can reduce pulmonary complications in children undergoing cardiac surgery. The aim of this study is to evaluate the effects of sugammadex for postoperative respiratory management in children with congenital heart disease. METHODS Sixty children with congenital heart disease undergoing elective cardiac surgery were divided into group S and group C (30 children in each group). When post tetanic twitches count (PTC) = 1-2 and train-of-four (TOF) = 0, the children in group S received sugammadex4 mg/kg for reversal of neuromuscular block at the end of surgery, and the children in group C received the same volume of normal saline. The recovery time to TOF of 0.9, the mechanical ventilation and extubation times were recorded. On the other side, the hemodynamic parameters before and 5 min after administration, and side effects were also recorded. The levels of C-reactive protein (CRP) and procalcitonin (PCT) before and 24 h after surgery were measured. RESULTS The recovery time to TOF of 0.9 and extubation time were significantly shorter in the group S than in the group C (4.2 ± 1.4 vs 108.2 ± 26.7 min, 66.3 ± 6.5 vs 171.6 ± 23.1 min, respectively, P < 0.01). The CRP and PCT levels were found to be increased in both groups at postoperative 24 h than before surgery. Further, the levels of PCT and CRP at postoperative 24 h were lower in group S when compared to group C (median, 7 vs 17.5 mg/ml, 1.76 vs 5.22 ng/ml, respectively, P < 0.05). There were no statistical differences observed between the two groups (P> 0.05) with respect to side effects. CONCLUSION Sugammadex is rapid and effective in reversing rocuronium-induced neuromuscular block, and significantly reduces the extubation time and the release of postoperative CRP and PCT in children with congenital heart diseases.
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