An institutional experience with epidural analgesia in children and young adults undergoing cardiac surgery.

Background: Allowing spontaneous respiration after cardiac surgery eliminates complications related to mechanical ventilation and optimizes cardiopulmonary interaction. Epidural analgesia has been proposed to promote early extubation after cardiac surgery.

Objective: To identify the characteristics of patients with epidural analgesia and safety profiles with respect to the timing of extubation following cardiac surgery.

Design And Method: A retrospective chart review of patients who underwent cardiac surgery during a 5-year period. Demographic, procedural, and perioperative variables were analyzed to investigate factors that affect the timing of extubation.

Results: A total of 750 records were reviewed. The patients' median age was 12 months, and 52% were infants (<1 year). Seventy-five percent of the patients utilized cardiopulmonary bypass. The study population was classified into three groups according to the timing of extubation: 66% were extubated in the operating room or upon arrival at the PICU (Immediate), 15% were extubated within 24 h (mean, 10.8 h; 95% CI, 9.0-12.6) (Early), and 19% were extubated after 24 h (Delayed). For the Immediate and Early groups, multivariate logistic regression identified young age, increased cross-clamp time, and inotrope score as independent risk factors for the need for mechanical ventilation. Postextubation respiratory acidosis (mean P(a)CO(2), 50 mmHg; 95% CI, 49-51) was well tolerated by all patients. There were no neurologic complications related to the epidural technique.

Conclusion: Epidural analgesia in children undergoing cardiac surgery provides stable analgesia without complications in our experience.