Early Extubation Following Open Heart Surgery in Pediatric Patients with Congenital Heart Diseases
UNGKAB PRAKANRA TTANA, M.D.*, SOMCHAI SRIYOSCHATI, M.D.**, SONGY OS V ALAIRUCHA, M.D.*, SAMPHANT PORNVILAWAN, M.D.**, TEERA VIT PHANCHAIPETCH, M.D.**
Affiliation : *Department of Anesthesiology, **Department of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Presented at the 9th Asian Australasian Congress of Anesthesiologists, November 6-11, 1994, Bangkok, Thailand.
The study of tracheal extubation time in pediatric patients who underwent open heart
surgery was performed in the period of 1990-1991 (group I) and 1992-May 1994 (group 2), com-
posed of 174 and 208 cases in group 1 and group 2 respectively. The criteria for extubation in
these patients are convention regimens with considered subsequent standard of CPB, such as
fully rewarmed, hemodynamic stable with adequate cardiac output with low-dose or no inotropes/
vasodilator, without significant dysrhythmias and no significant mediastinal bleeding. The dif-
ference of postoperative fluid management between the two groups include the regimens of total
fluid intake of two-thirds of daily maintenance fluid in group I, whereas, the total fluid therapy of
group 2 depended on the patients' age and body weight.
The results show that, early extubation within 8 hours of ICU arrival were 20.5 per cent and
61.7 per cent in group 1 and group 2 respectively. All of the patients in group 2, after extubation,
were discharged to the ward on the first postoperative day. The overnight ventilation was about
74.1 per cent and 30.6 per cent in the first and second groups respectively. The prolonged intubation
(more than 24 hours) was almost the same in two groups. There was no significant complication
of early extubation with the limitation of daily total fluid intake. The causes of tracheal reintuba-
tion in both groups were fluid overload and residual cardiac lesions. The prior etiology occurred in
group 1 more than group 2.
It was concluded that, after the change in postoperative fluid therapy regimens, early extu-
bation following open-heart pediatric surgery is highly successful with no significant complication.
The benefits of early extubation include cost savings, patient comfort, early patient mobilization,
improved cardiac function, reduced respiratory complications and reduction of case cancellation
due to early ICU discharge.
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