Altun Dilek, Arnaz Ahmet, Doğan Abdullah, Yalçinbaş Yusuf, Türköz Rıza, Oktay Ayla, Yüksek Adnan, Altun Demet, Sarıoğlu Tayyar
Department of Anesthesiology and Reanimation, Vocational School of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey.
Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey.
J Card Surg. 2022 Dec;37(12):4234-4242. doi: 10.1111/jocs.16709. Epub 2022 Jul 26.
After congenital cardiac surgery, the duration of mechanical ventilation (MV) is related to the clinical status, type of operation, and the sedative-analgesic agents used postoperatively. This study aims to examine the effects of dexmedetomidine and morphine on the fast-track extubation (FTE) and ultra-fast-track extubation (UFTE) protocol after congenital cardiac surgery.
A total of 251 pediatric patients were divided into two groups: 118 patients in the morphine group (Group M) and 133 patients in the dexmedetomidine group (Group D). We retrospectively reviewed medical data including hemodynamic parameters, duration of MV and cardiovascular intensive care unit (CICU), additional sedative/analgesic requirement, adverse events, the need for reintubation, and noninvasive MV, sedation, and pain scores.
The mean mechanical ventilation duration of Group D was significantly shorter than Group M (3.74 ± 0.83 h in Group D, 5.72 ± 1.54 h in Group M, respectively) (p = .001; p < .05). In Group D, the success rate of FTE was 92.5% (n = 123) and UFTE was 7.5% (n = 10) (p = .001). In Group M, the success rate of FTE was 72.9% (n = 86) and UFTE was 0% (n = 0) (p > .05).
Dexmedetomidine and morphine have clinical benefits which encourage their use for FTE protocol. Dexmedetomidine has more benefits compared to morphine. It can be used in UFTE protocol, besides its use in FTE protocol with fewer side effects.
先天性心脏手术后，机械通气（MV）的持续时间与临床状况、手术类型以及术后使用的镇静镇痛药物有关。本研究旨在探讨右美托咪定和吗啡对先天性心脏手术后快速拔管（FTE）和超快通道拔管（UFTE）方案的影响。
总共251例儿科患者被分为两组：吗啡组（M组）118例患者和右美托咪定组（D组）133例患者。我们回顾性分析了包括血流动力学参数、MV持续时间和心血管重症监护病房（CICU）住院时间、额外的镇静/镇痛需求、不良事件、再次插管的必要性以及无创MV、镇静和疼痛评分等医疗数据。
D组的平均机械通气持续时间显著短于M组（D组分别为3.74±0.83小时，M组为5.72±1.54小时）（p = 0.001；p < 0.05）。在D组，FTE成功率为92.5%（n = 123），UFTE成功率为7.5%（n = 10）（p = 0.001）。在M组，FTE成功率为72.9%（n = 86），UFTE成功率为0%（n = 0）（p > 0.05）。
右美托咪定和吗啡具有临床益处，鼓励在FTE方案中使用。与吗啡相比，右美托咪定有更多益处。它除了可用于FTE方案外，还可用于UFTE方案，且副作用较少。
