Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-19T11:09:57.014Z Has data issue: false hasContentIssue false
  • English
  • Français

The effect of ultra-fast track cardiac anaesthesia in infants and toddlers: a randomised trial

Part of: Surgery

Published online by Cambridge University Press:  08 September 2021

Jumian Feng ,
Huaizhen Wang ,
Liangming Peng  and
Xingrong Song Open the ORCID record for Xingrong Song [Opens in a new window]
Jumian Feng
Affiliation:
Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China
Huaizhen Wang
Affiliation:
Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China
Liangming Peng
Affiliation:
Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China
Xingrong Song*
Affiliation:
Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China
*
Author for correspondence: X. Song, Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, NO. 9 Jinsui Road, Guangzhou, Guangdong 510623, China. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The usefulness of ultra-fast track cardiac anaesthesia may give great benefits to patients; however, its usefulness has not been completely evaluated in infants and toddlers, who are generally considered the most difficult group for ultra-fast track cardiac anaesthesia.

Method:

A total of 130 children were allocated randomly into to a ultra-fast track cardiac anaesthesia group (Group D) or a conventional anaesthesia group (Group C) (each n = 65). In Group D, dexmedetomidine was administrated at a dosage of 1 µg/kg/hour after induction. The patient- controlled intravenous analgesia was dexmedetomidine and sufentanil. In Group C, patients were infused with of the same volume of normal saline, and sufentanil alone for patient-controlled intravenous analgesia. The dosages of sufentanil, extubation time, haemodynamic parameters, postoperative hospitalisation conditions, pain and sedation scores, blood gas analysis, and inotropic scores were all recorded.

Results:

The dosage of sufentanil (1.49 ± 0.05 vs. 3.81 ± 0.04 µg, p < 0.001) and extubation time (2.63 ± 0.52 vs. 436.60 ± 22.19 minutes, p < 0.001) in Group D were all significantly lower than those in Group C. Moreover, cardiac intensive care unit stay time, total hospital stay, hospitalisation costs, postoperative lactate levels, and inotropic scores were also significantly lower in Group D.

Conclusions:

Using of ultra-fast track cardiac anaesthesia in infants and toddlers is effective, it not only reduce the perioperative requirement for opioids and shorten the extubation time but also decreases the inotrope requirement and provide a better postoperative condition for young children.

Keywords

Ultra-fast track cardiac anaesthesiadexmedetomidinesufentanilinfantstoddlersCHD
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1092 - 1097
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hemmerling, TM, Prieto, I, Choiniere, JL, et al. Ultra-fast-track anesthesia in off-pump coronary artery bypass grafting: a prospective audit comparing opioid-based anesthesia vs thoracic epidural-based anesthesia. Can J Anaesth 2004; 51: 163–168.CrossRefGoogle ScholarPubMed
Mahmoud, M, Mason, KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth 2015; 115: 171–182.CrossRefGoogle ScholarPubMed
Kundra, S, Taneja, S, Choudhary, A, et al. Effect of a low-dose dexmedetomidine infusion on intraoperative hemodynamics, anesthetic requirements and recovery profile in patients undergoing lumbar spine surgery. J Anaesthesiol Clin Pharmacol 2019; 35: 248.CrossRefGoogle ScholarPubMed
Tobias, JD, Gupta, P, Naguib, A, et al. Dexmedetomidine: applications for the pediatric patient with congenital heart disease. Pediatr Cardiol 2011; 32: 1075–1087.CrossRefGoogle ScholarPubMed
Neema, PK. Dexmedetomidine in pediatric cardiac anesthesia. Ann Card Anaesth 2012; 15: 177–179.10.4103/0971-9784.97972CrossRefGoogle ScholarPubMed
Zuppa, AF, Nicolson, SC, Wilder, NS, et al. Results of a phase 1 multicentre investigation of dexmedetomidine bolus and infusion in corrective infant cardiac surgery. Br J Anaesth 2019; 123: 839–852.CrossRefGoogle ScholarPubMed
Turgut, N, Turkmen, A, Gökkaya, S, et al. Dexmedetomidine-based versus fentanyl-based total intravenous anesthesia for lumbar laminectomy. Minerva Anestesiol 2008; 74: 469.Google ScholarPubMed
Verrier, ED, Wright, IH, Cochran, RP, et al. Changes in cardiovascular surgical approaches to achieve early extubation. J Cardiothorac Vasc Anesth 1995; 9: 10–15.Google ScholarPubMed
Davis, S, Worley, S, Mee, RB, et al. Factors associated with early extubation after cardiac surgery in young children. Pediatr Crit Care Med 2004; 5: 63–68.CrossRefGoogle ScholarPubMed
Gonzalez-Gil, A, Villa, A, Millan, P, et al. Effects of dexmedetomidine and ketamine-dexmedetomidine with and without buprenorphine on corticoadrenal function in rabbits. J Am Assoc Lab Anim Sci 2015; 54: 299–303.Google ScholarPubMed
Bulow, NM, Colpo, E, Pereira, RP, et al. Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass. Braz J Med Biol Res 2016; 49: e4646.CrossRefGoogle Scholar
Pan, W, Wang, Y, Lin, L, et al. Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta-analysis. Paediatr Anaesth 2016; 26: 239–248.10.1111/pan.12820CrossRefGoogle ScholarPubMed
Su, F, Nicolson, SC, Zuppa, AF. A dose-response study of dexmedetomidine administered as the primary sedative in infants following open heart surgery. Pediatr Cri Care Med 2013; 14: 499–507.10.1097/PCC.0b013e31828a8800CrossRefGoogle ScholarPubMed
Yuki, K, Matsunami, E, Tazawa, K, et al. Pediatric perioperative stress responses and anesthesia. Transl Perioper Pain Med 2017; 2: 1–12.Google ScholarPubMed
Duncan, HP, Cloote, A, Weir, PM, et al. Reducing stress responses in the pre-bypass phase of open heart surgery in infants and young children: a comparison of different fentanyl doses. Br J Anaesth 2000; 84: 556–564.CrossRefGoogle ScholarPubMed
Reismann, M, von Kampen, M, Laupichler, B, et al. Fast-track surgery in infants and children. J Pediatr Surg 2007; 42: 234–238.CrossRefGoogle ScholarPubMed
Dong, CS, Zhang, J, Lu, Q, et al. Effect of Dexmedetomidine combined with sufentanil for post- thoracotomy intravenous analgesia: a randomized, controlled clinical study. BMC Anesthesiol 2017; 17: 33.10.1186/s12871-017-0324-4CrossRefGoogle ScholarPubMed
Rong, LQ, Kamel, MK, Rahouma, M, et al. High-dose versus low-dose opioid anesthesia in adult cardiac surgery: a meta-analysis. J Clin Anesth 2019; 57: 57–62.CrossRefGoogle ScholarPubMed
Naguib, AN, Tobias, JD, Hall, MW, et al. The role of different anesthetic techniques in altering the stress response during cardiac surgery in children: a prospective, double-blinded, and randomized study. Pediatr Crit Care Med 2013; 14: 481–490.10.1097/PCC.0b013e31828a742cCrossRefGoogle ScholarPubMed
Meissner, U, Scharf, J, Dötsch, J, et al. Very early extubation after open-heart surgery in children does not influence cardiac function. Pediatr Cardiol 2008; 29: 317–320.CrossRefGoogle Scholar
Amula, V, Vener, DF, Pribble, CG, et al. Changes in anesthetic and postoperative sedation-analgesia practice associated with early extubation following infant cardiac surgery: experience from the pediatric heart network collaborative learning study. Pediatr Crit Care Med 2019; 20: 931–939.CrossRefGoogle ScholarPubMed
Chrysostomou, C, Komarlu, R, Lichtenstein, S, et al. Electrocardiographic effects of dexmedetomidine in patients with congenital heart disease. Intensive Care Med 2010; 36: 836–842.CrossRefGoogle ScholarPubMed
Sarma, J, Narayana, PS, Ganapathi, P, et al. A comparative study of intrathecal clonidine and dexmedetomidine on characteristics of bupivacaine spinal block for lower limb surgeries. Anesth Essays Res 2015; 9: 195–207.CrossRefGoogle ScholarPubMed
Kumar, P, Thepra, M, Bhagol, A, et al. The newer aspect of dexmedetomidine use in dentistry: as an additive to local anesthesia, initial experience, and review of literature. Natl J Maxillofac Surg 2016; 7: 76–79.CrossRefGoogle ScholarPubMed
Hamilton, BCS, Honjo, O, Alghamdi, AA, et al. Efficacy of evolving early-extubation strategy on early postoperative functional recovery in pediatric open-heart surgery: a matched case-control study. Semin Cardiothorac Vasc Anesth 2014; 18: 290–296.CrossRefGoogle ScholarPubMed