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ULTRA-FAST-TRACK ANESTHESIA IN OFF-PUMP CARDIAC SURGERY: MAINTENANCE OF CORE TEMPERATURE IS MORE IMPORTANT THAN SPECIFIC ANESTHETIC TECHNIQUES

^* Université de Montréal, Departments of Anaesthesiology and
^# Cardiac Surgery, Hôtel-Dieu, 3840 Rue St-Urbain, Montréal, Quebec H2Y 1T8

INTRODUCTION

This study investigated whether operating room extubation could be achieved with a variety of anaesthetic techniques by maintaining core temperature during off-pump cardiac surgery (CABG).

METHODS

The study was designed as a prospective audit of 30 patients undergoing off-pump CABG. The goal was to maintain the patient's core temperature during surgery of more than 35.5°C by active temperature control. If extubation could not be achieved within 30 min after surgery (or core temperature was below 35.5), the patient was transferred to the ICU intubated and ventilated. Postoperative analgesia during the first 24 hours was achieved by either thoracic epidural analgesia (TEA)or patient controlled application of morphine (PCA). Data as means (SD).

RESULTS

Preliminary results of 17 patients (2 women, 15 men) of mean age of 59 yrs (8), weight of 83 (18) kg and an ejection fraction of 51 (11) % undergoing CABG with 3 grafts (0.7) during surgery of 140 (35) min are presented. Core temperature at extubation at 14 (8) min after the end of surgery was 35.9 (0.3) °C. Three patients were not extubated due to low core temperature. Intraoperative analgesia was achieved by fentanyl boli; sevoflurane (N=13) or isoflurane (N=4) was used to maintain a bispectral index between 40 and 60. No patient needed re-intubation. Postoperative analgesia was achieved by TEA of 0.125 % bupivacaine (N=6), adjusted according to the patient's pain score, after an initial bolus of 4-8 ml bupivacaine 0.125 % 15 min prior to extubation, or PCA (N=11, bolus 1 mg, lockout: 6 min). Pain scores postoperatively were comparably low in both groups (1.8 vs 1.4, first 24 h). First PO₂ and PCO₂ after surgery was 128 mmHg (36) and 43 mmHg (5) mmHg (FiO₂ = 100 %).

DISCUSSION

Preliminary results indicate that Ultra Fast Track anaesthesia can be achieved with conventional anaesthetic techniques. Maintenance of core body temperature is the most important task to allow operating room extubation.

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hemmerling, T. M. Articles by Prieto, I. Search for Related Content PubMed Articles by Hemmerling, T. M. Articles by Prieto, I.