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An evolving anesthetic protocol fosters fast tracking in pediatric cardiac surgery: A comparison of two anesthetic

Vipul K Sharma1, Gaurav Kumar2, Saajan Joshi1

  • 1Department of Cardio-Thoracic Anaesthesia, Army Hospital Research and Referral, New Delhi, India.

Annals of Pediatric Cardiology
|February 8, 2020
PubMed

Insights

Ketamine with low-dose fentanyl significantly reduces mechanical ventilation time and intensive care unit (ICU) stay in pediatric cardiac surgery patients. This anesthetic approach offers improved postoperative recovery compared to high-dose fentanyl.

Area of Science:

  • Pediatric Cardiac Surgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Advancements in surgical techniques for congenital heart defects necessitate optimized perioperative management.
  • Minimizing postoperative ventilation is crucial for improved patient outcomes in pediatric cardiac surgery.

Purpose of the Study:

  • To compare the efficacy of ketamine with low-dose fentanyl versus high-dose fentanyl for anesthetic induction in pediatric patients undergoing corrective/palliative cardiac surgery.
  • To evaluate the impact of these anesthetic regimens on postoperative extubation time and intensive care unit (ICU) stay.

Main Methods:

  • A randomized open-label trial involving 70 pediatric patients (<14 years) undergoing cardiopulmonary bypass (CPB) and epidural analgesia for congenital heart defects.
  • Patients were assigned to either ketamine with low-dose fentanyl (Group K) or high-dose fentanyl (Group F) for anesthetic induction.
  • Postoperative extubation time and ICU stay were compared using the Mann-Whitney U-test.

Main Results:

  • 32 out of 35 patients in Group K were extubated in the operating room, versus 18.1 ± 11 hours in Group F.
  • Total ICU stay was significantly shorter in Group K (45.2 ± 30.1 hours) compared to Group F (60.1 ± 24.5 hours) (P = 0.02).
  • Higher systolic blood pressure was observed in Group K.

Conclusions:

  • Anesthetic induction with ketamine and low-dose fentanyl is superior to high-dose fentanyl in reducing postoperative extubation time and ICU stay.
  • This anesthetic strategy improves early recovery for pediatric patients undergoing corrective/palliative surgery for congenital heart defects under CPB.
  • Ketamine-based anesthesia offers a beneficial alternative for perioperative management in this patient population.
Abstract

Keywords:
Epidural analgesiafast trackingneuraxial blockon-table extubationpediatric anesthesiapediatric cardiac surgery

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