Thorac Cardiovasc Surg 2018; 66(S 02): S111-S138
DOI: 10.1055/s-0038-1628353
Short Presentations
Tuesday, February 20, 2018
DGPK: Various II
Georg Thieme Verlag KG Stuttgart · New York

Extubation in the Operating Room after Fontan Operation

D. Kiski
1   Department of Paediatric Cardiology, University Hospital Muenster, Muenster, Germany
,
S. Kintrup
2   Division of Paediatric Cardiac Surgery, University Hospital Muenster, Muenster, Germany
,
C. Schmidt
3   Department of Anaesthesiology, University Hospital Muenster, Muenster, Germany
,
A. Brünen
3   Department of Anaesthesiology, University Hospital Muenster, Muenster, Germany
,
F. Kleinerüschkamp
1   Department of Paediatric Cardiology, University Hospital Muenster, Muenster, Germany
,
H.G. Kehl
1   Department of Paediatric Cardiology, University Hospital Muenster, Muenster, Germany
,
A. Uebing
1   Department of Paediatric Cardiology, University Hospital Muenster, Muenster, Germany
,
E. Malec
2   Division of Paediatric Cardiac Surgery, University Hospital Muenster, Muenster, Germany
,
K. Januszewska
2   Division of Paediatric Cardiac Surgery, University Hospital Muenster, Muenster, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

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Objective: Negative intrathoracic pressure caused by spontaneous ventilation is an important driving force for blood flow in Fontan circulation. The avoidance of positive pressure ventilation in the postoperative management is therefore of potential benefit. The goal of this study was to assess the impact of immediate postoperative extubation in the operating room on hemodynamics and early outcome after Fontan operation (FO) in comparison to later extubation on the intensive care unit.

Methods: Between 2013 and 2016, a total of 114 children (mean age 3.8 ± 2.3 years; mean weight 15.2 ± 6.8 kg) with univentricular cardiac defects underwent FO with an extracardiac conduit: 60 patients were immediately extubated in the operating room (IE group) and 54 on the intensive care unit (ICUE group) after a median of 195 minute. (range: 30–515 minutes). The medical pre-, intra- and postoperative data (191 parameters) were retrospectively analyzed.

Results: The overall hospital survival was 100%. Only one patient from the IE group needed reintubation because of laryngospasm. The mean hospital stay was 17.5 ± 6.8 days and did not differ between groups. Patients in the IE group had lower heart rate, arterial and central venous blood pressure and showed less frequently metabolic acidosis 2–3 hour after arrival on the ICU. Furthermore, less inotropic support and volume supplementation were needed throughout the postoperative course. Patients from the IE group had also less pleural effusions within the first 48 hours ([Table 1]).

IE (n = 60)

ICUE (n = 54)

p-Value

Heart rate [bpm]

106.5 ± 3.99

120.3 ± 5.96

<0.001

Blood pressure systolic/diastolic/central venous

90.6 ± 2.09/49.6 ± 1.38/10.4 ± 0.66

93.5 ± 6.43/53.6 ± 4.33/11.4 ± 1.42

0.024/<0.001/0.001

pH 2–3 h after FO

7.36 ± 0.04

7.30 ± 0.47

<0.001

Dopamine support [h]

9.75 ± 11.28

12.77 ± 11.68

0.033

Fluid requirement [mL/kg/24 h]

54.11 ± 31.19

73.76 ± 46.09

0.019

Effusions [mL/kg] 48 h after FO

37.9 ± 17.48

49.5 ± 26.10

<0.001

Conclusion: Immediate extubation in the operating theater after the FO is feasible, safe and can be routinely performed. This regimen seems to promote faster hemodynamic adaptation to the Fontan circulation with less therapeutic interventions and therefore is a recommendable modification of the management.