Tracheal extubation of children in the operating room after atrial septal defect repair as part of a clinical practice guideline

• Published in: Anesthesia and analgesia Vol. 82; no. 5; pp. 988 - 993
• Main Authors: LAUSSEN, P. C, REID, R. W, STENE, R. A, PARE, D. S, HICKEY, P. R, JONAS, R. A, FREED, M. D
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.05.1996
• Subjects: Acidosis, Respiratory - etiology; Anesthesia, Intravenous - economics; Anesthetics, Intravenous - administration & dosage; Biological and medical sciences; Body Temperature; Boston; Cardiopulmonary Bypass; Child; Critical Care - economics; Fentanyl - administration & dosage; Heart Septal Defects, Atrial - surgery; Hematocrit; Hospital Charges; Hospitals, Pediatric; Humans; Intubation, Intratracheal - economics; Length of Stay; Medical sciences; Operating Rooms - economics; Postoperative Complications; Practice Guidelines as Topic; Respiration, Artificial - economics; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Treatment Outcome; Vomiting - etiology; Boston; Human; Cardiovascular disease; Intracardiac defect; Artificial ventilation; Congenital disease; Extubation; Recommendation; Intensive care unit; Clinical management; Malformation; Heart disease; Operating room; Surgery; Atrial septal defect; Child; Trachea; Comparative study
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-199605000-00017

Early tracheal extubation in the operating room after atrial septal defect (ASD) surgery was recommended as part of a clinical practice guideline (CPG) established in the Cardiovascular Program at the Children's Hospital, Boston, MA. This retrospective review was undertaken to determine whether this practice was efficient without compromising patient care. The charts and hospital charges for 102 patients undergoing secundum ASD or sinus venosus defect surgery between March 1992 and July 1994 were reviewed; 36 patients (Group I) had surgery prior to introduction of the CPG, and 66 patients were managed according to the CPG. Of the latter, 25 patients (Group II) were tracheally extubated in the operating room (OR) and 41 patients (Group III) were extubated in the cardiac intensive care unit (CICU). Patients in all three groups were similar with respect to height, weight, and surgical conditions including cardiopulmonary bypass time, lowest esophageal temperature, hematocrit, total OR time, and the time from completion of bypass to leaving the OR. Patients in Group II received significantly less fentanyl during anesthesia, were more likely to have a respiratory acidosis on admission to the CICU, and had an increased frequency of vomiting in the CICU. There was no difference in duration of CICU stay among groups. The length of hospital stay was reduced in Groups II and III after introduction of the CPGs, but was not influenced by tracheal extubation in the OR. There was no difference among groups in the hospital charges for OR, anesthesia and CICU time. However, when the combined hospital charges for services provided both in the OR and CICU were included, patients in Group II were charged significantly less, and this primarily reflects the absence of postoperative mechanical ventilation charges. Tracheal extubation in the OR after ASD surgery in children can result in lower patient charges without significantly compromising patient care.