Visoiu Mihaela, Parry Stephanie, Augi Tyler H, Lavage Danielle R, Licata Scott E, Turula Holly A, Soliman Doreen E
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15261, USA.
Department of Anesthesiology and Perioperative Medicine, Department of Pediatrics, Division of Newborn Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15261, USA.
Children (Basel). 2025 Feb 24;12(3):275. doi: 10.3390/children12030275.
BACKGROUND/OBJECTIVES: Continuous epidural analgesia is desirable for improving infant outcomes after surgeries. However, its contribution to facilitating extubation is not well known.
A retrospective chart review was conducted at the UPMC Children's Hospital of Pittsburgh to identify all infants who received an epidural catheter between 2018 and 2024 and required postsurgical admission to the Neonatal Intensive Care Unit (NICU). The study examined the timing of extubation and reintubation, along with associated factors, in 100 infants who underwent major surgeries.
In total, 100 infants, 43 females and 57 males, 40 (38.39-42.07) weeks corrected gestational age, 3 (2.52-3.42) kg received epidural catheters. Sixty-two patients had a pulmonary condition. Of 45 infants extubated in the operating room, 32 received fentanyl intraoperatively, and 16 required a morphine infusion in the NICU. Among 55 infants that remained intubated, 24% underwent a thoracic procedure, 46 received intraoperatively fentanyl, and 21 needed an opioid infusion postoperatively. The extubation day was median (IQR) 2 (1-4), and 24% remained intubated beyond day 5. Twelve infants were intubated preoperatively, and six required prolonged ventilation beyond day 5. Of 15 infants that required reintubation, 8 received a morphine infusion. The medians (IQR) of the average of three pain and sedation scores before reintubation were 1.67 (1-3) and 0 (-1.67-0), respectively.
Epidural analgesia may facilitate early extubation in some infants undergoing surgeries. Morphine infusion was administered at a similar rate between infants extubated and those who remained intubated, and its role in delaying extubation timing remains unclear.
背景/目的：连续硬膜外镇痛有助于改善婴儿术后的预后。然而，其对促进拔管的作用尚不明确。
对匹兹堡大学医学中心儿童医院进行了一项回顾性病历审查，以确定2018年至2024年间接受硬膜外导管置入且术后需入住新生儿重症监护病房（NICU）的所有婴儿。该研究调查了100例接受大手术的婴儿的拔管和重新插管时间以及相关因素。
共有100例婴儿接受了硬膜外导管置入，其中43例为女性，57例为男性，矫正胎龄40（38.39 - 42.07）周，体重3（2.52 - 3.42）kg。62例患者有肺部疾病。在手术室拔管的45例婴儿中，32例术中接受了芬太尼，16例在NICU需要吗啡输注。在仍需插管的55例婴儿中，24%接受了胸部手术，46例术中接受了芬太尼，21例术后需要阿片类药物输注。拔管日的中位数（四分位间距）为2（1 - 4）天，24%的婴儿在第5天后仍需插管。12例婴儿术前插管，6例在第5天后需要长时间通气。在15例需要重新插管的婴儿中，8例接受了吗啡输注。重新插管前三个疼痛和镇静评分的平均值的中位数（四分位间距）分别为1.67（1 - 3）和0（-1.67 - 0）。
硬膜外镇痛可能有助于一些接受手术的婴儿早期拔管。拔管和仍需插管的婴儿中吗啡输注的比例相似，其在延迟拔管时间方面的作用尚不清楚。
