Fast tracking in paediatric cardiac anaesthesia: an update

Area of Science:

• Cardiology
• Pediatric Surgery
• Anesthesiology

Background:

• Fast track care plans accelerate recovery and discharge for cardiac surgical patients.
• While established in adults, fast track protocols are increasingly applied to pediatric cardiac surgery.
• Current evidence lacks randomized controlled trials for pediatric fast track efficacy regarding cost and complications.

Purpose of the Study:

• To review the components and applicability of fast track protocols in pediatric cardiac surgery.
• To highlight the potential benefits and current limitations of expedited postoperative care in children.

Main Methods:

• Review of fast track clinical guidelines, including same-day surgery, short-acting anesthetics, early extubation, and pain management.
• Discussion of essential components: minimally invasive surgery, modified ultrafiltration, transesophageal echocardiography, and postoperative pain control.
• Analysis of expert opinions on managing pediatric patients with expedited postoperative protocols.

Main Results:

• Fast track protocols are suitable for simple pediatric cardiac procedures like septal defect repairs.
• Many pediatric cardiac anesthesiologists believe expedited protocols can manage most patients without significant pulmonary or cardiac issues.
• Implementation of key techniques allows for early extubation in 80-90% of pediatric patients.

Conclusions:

• Fast track protocols show promise for improving outcomes in pediatric cardiac surgery.
• Further multicenter, randomized controlled trials are necessary to definitively establish the efficiency and effectiveness of pediatric fast track programs.