The Role of Fast Track Extubation in Enhance Recovery after Pediatric Cardiac Surgery
Mohammad Makbul Hossain
Department of Pediatric Cardiac Anesthesia & ICU, Shishu Hospital and Institute, Bangladesh.
Sabarin Ahamed
Gynae and Obs, Shaheed Suhrawardy Medical College Hospital, Bangladesh.
Khalifa Mahmud Tarik
Cardiac Surgery, Bangladesh Shishu Hospital and Institute, Bangladesh.
Md. Yousuf Hira
Cardiac Surgery, Bangladesh Shishu Hospital and Institute, Bangladesh.
Partha Shekhar Roy
Cardiac Anesthesia, Bangladesh Shishu Hospital and Institute, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Background: By allowing patients to be extubated from their ventilators in the intensive care unit (ICU) as soon as they have stabilized, fast-track anesthesia (FTA) hastens the return to full awareness and independent breathing after surgery.
Objective: In this study our main goa is to evaluate the role of fast track extubation in enhance recovery after pediatric cardiac surgery.
Method: This prospective study was carried out at tertiary hospital from January 2021 from January 2022 where total of 200 CHD children, aged 6 months to 2 years and admitted to tertiary hospital, were selected for this study. During the study, 200 patients were randomly divided into two groups each consisting of 100 patients, and were subjected to fast track anesthesia and conventional anesthesia before surgeries.
Results: During the study, in fast track anesthesia group mean age was 1.2 ± 0.5 years, followed by 55 cases were female, 47 were preterm patients, mean anesthesia times was 3.5 ± 1.2 h, mean surgery time was 295.1 ± 22.9 min, mean CPB time was 47.2 ± 11.8, mean block time or a total allocated amount of time for a surgeon was 30.2 ± 8.9. whereas in conventional anesthesia group, mean age was 1.1 ± 0.5 years, followed by 40 cases were female, 45 were preterm patients, mean anesthesia times was 3.2 ± 1.0 h, mean surgery time was 288.0 ± 20.5 min, mean CPB time was 46.2 ± 10.7, mean block time was 31.5 ± 9.1. in fast track group mean extubation time was 22.9 ± 3.5 min followed by mean postoperative hospital stay was 11.5 ± 3.0 days, besides that, at extubation SAS score was 3.8 ± 0.6a and 24h post operation SAS score was 4.0 ± 0.5. Whereas in conventional group mean extubation time was 189.1 ± 31.2 min followed by mean postoperative hospital stay was 16.1 ± 2.4, besides that, at extubation SAS score was 4.8 ± 0.7and 24h post operation SAS score was 3.9 ± 0.5. MAP, HR and CVP between children outcome was measured based different time interval (T0 to T5) Moreover, no significant changes were noticed between two group.
The number of patients with ventilator-associated pneumonia was less in fast track group than in conventional group (P < 0.05). In fast track group arrhythmia cases were seen in 1% cases followed by 1% infection cases were seen, bleeding seen in 1%. Whereas in conventional group arrhythmia cases were seen in 2% cases followed by 1% infection cases were seen, bleeding seen in 2%.
Conclusion: Fast Track Anesthesia generates stable hemodynamics during operation, shorter extubation time, shorter ICU and hospitalization stay without increase in adverse reactions. It is worthy of recommendation for clinical practice.
Keywords: Fast track anesthesia, cardiac surgery, congenital anesthesia, Riker Sedation-Agitation Scale (SAS)