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Extubation in the Operating Room After Fontan Procedure: Does It Make a Difference?

Sebastian Kintrup1, Edward Malec1, Daniela Kiski2

  • 1Division of Pediatric Cardiac Surgery, University Hospital Muenster, Albert-Schweitzer-Campus1-Geb.A1, 48149, Muenster, Germany.

Pediatric Cardiology
|September 22, 2018
PubMed

Insights

Extubating children on the operating table after Fontan operation (FO) improved hemodynamics and reduced interventions compared to later extubation. This early extubation strategy in pediatric cardiac surgery shows significant benefits for early recovery.

Area of Science:

  • Pediatric Cardiac Surgery
  • Cardiovascular Physiology
  • Critical Care Medicine

Background:

  • The Fontan operation (FO) is a complex procedure for single ventricle heart malformations.
  • Early extubation is hypothesized to benefit the Fontan circulation's early postoperative course.

Purpose of the Study:

  • To compare the impact of intraoperative extubation versus early intensive care unit extubation on the early postoperative course following Fontan operation in children.

Main Methods:

  • Retrospective analysis of pre-, peri-, and postoperative records of 114 children undergoing FO (2013-2016).
  • Patients were divided into two groups: extubated in the operating room (ORE, n=60) and extubated in the intensive care unit (ICUE, n=54).
  • Comparison of hemodynamic parameters, fluid balance, medication use, and metabolic status within the first 48 hours post-operation.

Main Results:

  • The ORE group demonstrated lower heart rate and central venous pressure, and higher systolic blood pressure within 24 hours post-FO.
  • ORE patients experienced significantly less pleural effusion, reduced intravenous fluid administration, and required less inotropic support and antibiotics.
  • The ICUE group had a higher incidence of metabolic acidosis 3-4 hours post-FO.

Conclusions:

  • Immediate extubation in the operating room following Fontan operation is associated with improved early hemodynamic stability.
  • This strategy may lead to reduced therapeutic interventions, including fluid management, inotropic support, and antibiotic use.
  • Intraoperative extubation appears to be a safe and beneficial approach for the early postoperative management of pediatric patients after Fontan operation.

Keywords:
Congenital cardiac defectsExtubationFontan operationSingle ventricle

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