The desire to reduce hospital costs and the iatrogenic complications showed interest in clinical practice guidelines which included use of short acting anesthetic drugs, early extubation, reduced intensive therapy and hospital stay for pediatric patients. With the escalating number of pediatric patients requiring cardiac surgery, efficient use of facilities by fast track cardiac anesthesia and resource utilization resulted in the adoption of early tracheal extubation techniques in cardiac surgery. Fast track approach in cardiac surgery is a perioperative process which involves rapid progress from preoperative through intra operative and discharge from hospital. Early extubation is one of the major components of fast track.

Recent technological advances in diagnostic cardiology, anesthesia, surgery, extracorporeal techniques and perioperative management strategies contributed to successful early extubation. This avoids potentially deleterious effects of mechanical ventilation such as – laryngotracheal trauma, barotrauma, pneumothorax, mucus plugging in the endotracheal tube, incorrect positioning, kinking of the tube, accidental extubation and ventilator associated pneumonia . In order to reduce or eliminate these adverse effects of prolonged intubation and to reduce the hospital costs and iatrogenic complications, we studied the concept of early extubation that is within four hours after surgery in surgical closure of ventricular septal defect.

The purpose of the present study was to determine the feasibility of early extubation and to know the risk factors for delayed extubation in children who underwent surgical closure of the ventricular septal defect. The goal was to extubate as many patients as feasible within four hours after surgery. This was defined as early extubation.

This is a prospective study of 87 consecutive patients undergoing surgical closure of ventricular septal defect between January 2010 and April 2010. The essential aspects of early extubation included choice of anesthetic agents, hemodynamic stability and good postoperative analgesia. The anesthesia was induced with intramuscular ketamine 5 mg/kg and glycopyrrolate 10 mcg/kg. Vecuronium 0.1 5mg/kg was given to facilitate intubation. Maintenance anesthesia consisted of titrated doses of fentanyl (1 mcg/kg boluses), low concentration of sevoflurane, midazolam (0.05 mg/kg) and vecuronium (0.5-0.1mg/kg) as clinically indicated.

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ISSN: 2155-9880

Current Issue: Volume 11, Issue 7

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Journal of Clinical and Experimental Cardiology