ArticlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2019
Changes in Anesthetic and Postoperative Sedation-Analgesia Practice Associated With Early Extubation Following Infant Cardiac Surgery: Experience From the Pediatric Heart Network Collaborative Learning Study.
Article in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A systematic review of dexmedetomidine pharmacology in pediatric patients.Clinical and translational science · 2024Pooled it
- Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial.Critical care (London, England) · 2024Trial
- Sugammadex: Safety Profile and Adverse Effects in Infants Less Than Two Years of Age With Congenital Heart Disease.Cardiology research · 2026Article
- The effect of perioperative dexmedetomidine on early extubation time in patients undergoing pediatric cardiac surgical patients: A retrospective cohort study.Turk gogus kalp damar cerrahisi dergisi · 2026Article
- Prolonged Mechanical Ventilation and Extubation Failure in Children and Adolescents Undergoing Cardiac Surgery.Brazilian journal of cardiovascular surgery · 2025Article
- Efficacy and safety of analgosedation with dexmedetomidine in critically ill mechanically ventilated children: a systematic review and meta-analysis of randomized controlled trials.Intensive care medicine. Paediatric and neonatal · 2025Article
- Perioperative Factors and Radiographic Severity Scores for Predicting the Duration of Mechanical Ventilation After Arterial Switch Surgery.Journal of cardiothoracic and vascular anesthesia · 2024Article
- Higher Cumulative Dose of Opioids and Other Sedatives are Associated with Extubation Failure in Norwood Patients.Pediatric cardiology · 2024Article
- Perioperative dexmedetomidine compared to midazolam in children undergoing open-heart surgery: A pilot randomised controlled trial.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2023Article
- Efficacy of two doses of dexmedetomidine on attenuating cardiovascular response and safety of respiratory tract to extubation.Journal of cardiovascular and thoracic research · 2023Article
- Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit.Journal of anesthesia, analgesia and critical care · 2022Review
- Early extubation is associated with improved outcomes after complete surgical repair of pulmonary atresia with ventricular septal defect and hypoplastic pulmonary arteries in pediatric patients.Journal of cardiothoracic surgery · 2021Article
- Dexmedetomidine in paediatric anaesthesia.BJA education · 2020Review
- Influence of Early Extubation Location on Outcomes Following Pediatric Cardiac Surgery.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2020Article
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10 authors.
Funding
Abstract
objectivesThe Pediatric Heart Network sponsored the multicenter Collaborative Learning Study that implemented a clinical practice guideline to facilitate early extubation in infants after repair of isolated coarctation of the aorta and tetralogy of Fallot. We sought to compare the anesthetic practice in the operating room and sedation-analgesia management in the ICU before and after the implementation of the guideline that resulted in early extubation.
designSecondary analysis of data from a multicenter study from January 2013 to April 2015. Predefined variables of anesthetic, sedative, and analgesia exposure were compared before and after guideline implementation. Propensity score weighted logistic regression analysis was used to determine the independent effect of intraoperative dexmedetomidine administration on early extubation.
settingFive children's hospitals. PATIENTS: A total of 240 study subjects who underwent repair of coarctation of the aorta or tetralogy of Fallot (119 preguideline implementation and 121 postguideline implementation).
interventionsNone. MEASUREMENTS AND MAIN
resultsClinical practice guideline implementation was accompanied by a decrease in the median total intraoperative dose of opioids (49.7 vs 24.0 µg/kg of fentanyl equivalents, p < 0.001) and benzodiazepines (1.0 vs 0.4 mg/kg of midazolam equivalents, p < 0.001), but no change in median volatile anesthetic agent exposure (1.3 vs 1.5 minimum alveolar concentration hr, p = 0.25). Intraoperative dexmedetomidine administration was associated with early extubation (odds ratio 2.5, 95% CI, 1.02-5.99, p = 0.04) when adjusted for other covariates. In the ICU, more patients received dexmedetomidine (43% vs 75%), but concomitant benzodiazepine exposure decreased in both the frequency (66% vs 57%, p < 0.001) and cumulative median dose (0.5 vs 0.3 mg/kg of ME, p = 0.003) postguideline implementation.
conclusionsThe implementation of an early extubation clinical practice guideline resulted in a reduction in the dose of opioids and benzodiazepines without a change in volatile anesthetic agent used in the operating room. Intraoperative dexmedetomidine administration was independently associated with early extubation. The total benzodiazepine exposure decreased in the early postoperative period.
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