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Fast-tracking with continuous thoracic epidural analgesia in paediatric congenital heart surgeries: an institutional experience

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

To assess the success of fast-tracking in infants and small children undergoing paediatric cardiac surgery under general anaesthesia with continuous thoracic epidural analgesia (TEA).

Methodology

It is a retrospective study at a tertiary care hospital. A total of 461 children, aged 12 years or younger, were operated for congenital heart disease over a 2-year period from January 2018 to December 2019. After the exclusion of 71 patients, data from the remaining 390 patients were analysed.

Measurements and main results

The median time for extubation after intensive care unit admission was 2 h and 25 min (0–20 h). Extubation within 6 h was achieved in 215 patients (~ 55%). Patients in the early extubation group had significantly shorter hospital stay (4.1 ± 2.3 vs 6.9 ± 3.9 days, p = 0.004) than patients in the ventilated group. Reintubation was required in 27 (6.9%) patients. Thirteen patients died postoperatively on ventilator. Patients with low nadir temperature intraoperatively and cardiopulmonary bypass time > 90 min significantly predicted failure in fast-tracking with an odds ratio (OR) = 1.27; CI: 1.18–1.38 and OR = 2.3; CI: 1.8–2.96 respectively. The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery mortality score, younger age, Down syndrome and high vasopressor inotropic score did not adversely affect early extubation, contrary to contemporary concerns.

Conclusions

A multimodal approach for perioperative pain relief and sedation consisting of propofol and dexmedetomidine infusion along with TEA ensures early extubation in 59% of the cases undergoing paediatric cardiac surgery. Our data suggests that fast-tracking is feasible with safe and superior outcomes in a subset of appropriate patients undergoing paediatric cardiac surgery.

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Acknowledgements

We thank Dr. (Brig) Vipul Sharma, Professor (Cardiac Anaesthesiologist), Dr. DY Patil Medical College, Pune, for formulating the fast-track protocol in the organisation over the years and guiding us in safe practice of paediatric cardiac surgery. Thank you.

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Authors and Affiliations

  1. Department of Anaesthesia & Critical Care, Army Hospital (Research & Referral), Delhi Cantt, New Delhi, 110010, India

    Alok Kumar & Saajan Joshi

  2. Department of Paediatrics, Army Hospital (Research & Referral), Delhi Cantt, New Delhi, 110010, India

    H. R. Ramamurthy & Vivek Kumar

  3. Department of Cardiothoracic Surgery, Army Hospital (Research & Referral), Delhi Cantt, New Delhi, 110010, India

    Nikhil Tiwari & Gaurav Kumar

  4. Department of Anaesthesia & Critical Care, Dr. DY Patil Medical College, Pune, India

    Vipul Sharma

Authors
  1. Alok Kumar
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  2. H. R. Ramamurthy
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  3. Nikhil Tiwari
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  4. Saajan Joshi
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  5. Gaurav Kumar
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  6. Vivek Kumar
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  7. Vipul Sharma
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Corresponding author

Correspondence to Alok Kumar.

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CTRI NO CTRI/2022/01/039585.

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Kumar, A., Ramamurthy, H.R., Tiwari, N. et al. Fast-tracking with continuous thoracic epidural analgesia in paediatric congenital heart surgeries: an institutional experience. Indian J Thorac Cardiovasc Surg 38, 469–480 (2022). https://doi.org/10.1007/s12055-022-01373-8

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  • DOI: https://doi.org/10.1007/s12055-022-01373-8

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