Early Tracheal Extubation, Enhanced Recovery After Pediatric Cardiac Surgery, Regional Anesthesia and Postoperative Pain Management

In recent years a trend toward earlier extubation and enhanced recovery after cardiac surgery for many patients has decreased the length of ICU and hospital stay and has enhanced patient and family satisfaction, as well as reduced overall costs of congenital heart surgery. This chapter explores the history of early extubation and fast-tracking, explains the concept of enhanced recovery after pediatric cardiac surgery, and assesses the feasibility of such a program. Then, patient selection and implementation of fast-tracking from an institutional perspective are presented. Anesthetic technique, surgery and bypass considerations, and factors leading to failed extubation and prolonged mechanical ventilation are also discussed. Next, a discussion of the benefits of fast-tracking, and concerns and safety are presented. Finally, neuraxial and regional anesthesia techniques are reviewed, along with a perspective on their place in early recovery protocols.