Feasibility and safety of on table extubation after corrective surgical repair of tetralogy of Fallot in a developing country: A case series.

Fast‑track extubation is an established safe practice in pediatric congenital heart disease (CHD) surgical patients. On table extubation (OTE) in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF) cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post‑TOF repair complications such as low cardiac output state and arrhythmias. The objective of the case series was to determine the safety and feasibility of OTE in elective TOF total correction cardiac surgical patients with an integrated team approach. To the best of our knowledge, this is the first reported case series. A total of 8 elective male and female TOF patients were included. Standard anesthetic, surgical and perfusion techniques were used in these procedures. All patients were extubated in the operating room safely without any complications with the exception of one patient who continued to bleed for 3 h of postextubation at 2–3 ml/kg/h which was managed with transfusion of fresh frozen plasma at 15 mL/kg, packed red blood cells 10 mL/kg and bolus of transamine at 20 mg/kg. Apart from better surgical and bypass techniques, the most important factor leading to successful OTE was an excellent analgesia. On the basis of the case series, it is suggested to extubate selected TOF cardiac surgery repair patients on table safely with integrated multidisciplinary approach.

Down syndrome with Morgagni hernia and hypothyroidism

A rare association of Down syndrome with hypothyroidism and Morgagni type of diaphragmatic defect is described in a one-year-old male child who presented with a history of recurrent chest infections and delayed milestones. He showed obvious features of Down syndrome but was also found to have hypothyroidism on investigations. Morgagni hernia was suspected on lateral chest X-ray and confirmed by CT scan thorax. He responded well to the management, which included surgical repair of the hernia