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IMMEDIATE EXTUBATION AFTER CARDIAC SURGERY AS A ROUTINE METHOD: FIRST EXPERIENCE AFTER 275 PATIENTS

^* Department of Anesthesiology and Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Hôtel-Dieu, 3840, rue Saint-Urbain, Montréal, Québec, Canada, H2W 1T8

INTRODUCTION

This study presents the results of routine immediate extubation after cardiac surgery in 275 patients. Analgesia was provided either with high thoracic epidural (TEA), PCA morphine alone or in association with paravertebral blocs.

METHODOLOGY

275 patients undergoing cardiac surgery with an ejection fraction of at least 25 % were included in this prospective, non-randomized audit. Patients received one of the three sorts of analgesia: A)analgesia based on TEA (bupivacaine 0.125 % 4–16 ml/h), B)analgesia based on fentanyl bolus (< 15 µg/kg total) + remifentanil during surgery and po. PCA using morphine or C)analgesia based on bilateral paravertebral blocks (single shot technique) + fentanyl (< 15 µg/kg total) bolus + remifentanil infusion during surgery followed by patient controlled analgesia with PCA morphine. Primary analgesic regimen was TEA. If patients refused TEA or were on anticoagulative therapy, postop. analgesia was PCA morphine (bolus: 1 mg; lockout: 6 min) alone or with paravertebral blocks performed before surgery. Anesthesia was induced using fentanyl 2–3 µg/kg, propofol 1–2 mg/kg, and maintained using sevoflurane titrated to a BIS of 40–50.

RESULTS

The anthropometric data and surgery-related parameters (concomitant diseases, ejection fraction, number of grafts, ischemic time, time of surgery, extubation time, patients temperature) and postoperative pain scores immediately and up to 48 h were recorded and compared. 275 consecutive patients were successfully extubated after cardiac surgery. 212 had coronary artery bypass (13 on-pump and 199 off-pump). 63 patients had simple or combined aortic(55) or mitral(8) valve replacement. 196 patients had an high thoracic epidural, 64 had PCA-morphine and 15 had paravertebral blocks + PCA-morphine. Immediate post-operative pain scores in these groups were 1.14(1.88), 4.26(2,59), 3.93(2.36) respectively, in favor of the TEA group. Mean extubation time after surgery was 10 min without significant differences between groups. There was no complication related to epidural catheter. Only two patients needed reintubation.

DISCUSSION

This audit shows the feasibility of immediate extubation after cardiac surgery with either high thoracic epidural or a conventional low dose fentanyl + remifentanil balanced anesthesia. Significantly better postoperative pain scores were achieved with TEA.

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 Olivier, J.-F. Articles by Hemmerling, T. M Search for Related Content PubMed Articles by Olivier, J.-F. Articles by Hemmerling, T. M