Fast-track cardiac anaesthesia safe, effective for ASD closure in kids

Fast-track cardiac anaesthesia (FTCA) using a combination of remifentanil and dexmedetomidine is effective and safe for the transthoracic device closure of atrial septal defect (ASD) in children, according to a new study.

“Remifentanil combined with dexmedetomidine as FTCA for transthoracic device closure of ASD in paediatric patients can stabilize the haemodynamics in the perioperative period, reduce the incidence of postoperative agitation, and effectively reduce postoperative pain,” the researchers said.

Data from 61 children undergoing ASD closure were included in the present retrospective analysis. Participants were divided into two according to whether or not FTCA was administered: group F, who received fast-track anaesthesia (n=31), and group R, who were given routine anaesthesia (n=30). Remifentanil and dexmedetomidine were used in the maintenance of analgesia in the former subgroup, while sufentanil was used in the latter.

Both subgroups were not significantly different in terms of baseline characteristics, showing comparable ages, sex distribution, and body weight. Preoperative ASD size in group F was slightly larger than that in group R (18.3±5.0 vs 17.1±6.2 mm; p=0.80), while the opposite was true as regards pulmonary arterial pressure (30.3±4.6 vs 30.8±5.5 mm Hg; p=0.82). [Heart Surg Forum 2021;24:E233-E238]

Successful device ASD closure was achieved in all patients. Postoperative sedation, as assessed by the Ramsay Sedation Scale (RSS), was significantly better in patients who received FTCA.

For instance, 1 hour after extubation, the mean RSS scores in groups F and R were 3.4±0.5 and 1.6±0.5, respectively (p=0.00). The same effect persisted until 4 hours after extubation (2.7±0.5 vs 1.7±0.5, respectively; p=0.00).

Similarly, patients who were given FTCA required a significantly lower level of postoperative care. The duration of mechanical ventilation was shorter in group F than in group R (0.2±0.1 vs 1.2±0.4 hours; p=0.00), as was the length of stay in the intensive care unit (1.6±0.2 vs 3.4±0.2 hours; p=0.00).

On the other hand, postoperative pain scores, as measured by the face, legs, activity, cry, and consolability (FLACC) score, did not differ between groups. Intraoperative mean arterial blood pressure and heart rate at different time points likewise remained statistically comparable between arms.

“The development of minimally invasive cardiac surgery also necessitates higher requirements for corresponding anaesthesia methods,” the researchers said. “FTCA mainly adjusts the use of appropriate anaesthetic drugs to improve the depth of anaesthesia and meet surgery requirements.”

“The combination of FTCA and transthoracic device closure of ASD in children will enable patients to recover faster, reduce complications, and improve utilization of medical resources,” they added. Future studies are needed to verify these findings in prospective randomized controlled trials, employing larger samples.