Immediate extubation in the operating room after cardiac operations with thoracotomy and sternotomy
Journal
Acta Anaesthesiologica Taiwanica
Journal Volume
45
Journal Issue
1
Pages
3-8
Date Issued
2007
Author(s)
Abstract
Background: Immediate extubation after cardiac operations in the operating room (OR) is rarely practised in Taiwan. The increased use of the minimally invasive and off-pump coronary artery bypass surgery (CABG) and the financial pressure from health insurance have raised the interest of its application after cardiac operations. The purpose of the study was to investigate the practice of immediate extubation in patients undergoing cardiac operations via minimal invasive thoracotomy against via midline sternotomy. Methods: Seventy unselected consecutive patients undergoing cardiac operations via either minimally invasive thoracotomy or midline sternotomy were enrolled for investigation. Anesthetic management, including bispectral index and continuous train-of-four (TOF) monitoring, was modified to extubate the patients in the OR within 15 min after the closure of the skin wound. Extubation criteria based on clear consciousness, recovery of muscle power, and stable hemodynamics without purposeful strong inotropic support were stipulated. Patient-controlled analgesia was used to provide adequate postoperative pain control. Results: Extubation within 15 min after the end of surgery was successful in all patients who underwent thoracotomy while there were five patients who could not be extubated in the sternotomy group. The PaCO2 values 30 min after extubation and the ICU stay were significantly higher and longer in patients of the sternotomy group. The pain intensity after extubation or the doses of analgesics used did not differ between two groups of patients. There was only one patient in the sternotomy group who needed reintubation and there was no postoperative death in both groups of patients. Conclusions: We consider that immediate extubation after cardiac procedures either through thoracotomy or sternotomy is a rather safe practice and if possible minimally invasive technique should be chosen because it causes smaller wound and offers safer immediate extubation and shorter ICU stay.
Subjects
Analgesia; Anesthesia recovery period; Cardiac surgical procedures; Extubation; Pain; Patient-controlled; Postoperative
SDGs
Other Subjects
atropine; catecholamine; desflurane; edrophonium; etomidate; fentanyl; ketorolac; morphine; oxygen; pethidine; rocuronium; adult; aged; anesthesia induction; arterial carbon dioxide tension; article; bispectral index; clinical practice; clinical protocol; consciousness; controlled study; endotracheal intubation; extubation; female; heart disease; hemodynamics; human; inotropism; intensive care unit; length of stay; major clinical study; male; minimally invasive cardiac surgery; muscle strength; operating room; patient controlled analgesia; patient monitoring; patient safety; postoperative pain; postoperative period; sternotomy; surgical approach; surgical mortality; surgical technique; surgical wound; suturing method; thoracotomy; Adult; Aged; Cardiac Surgical Procedures; Coronary Artery Bypass; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Operating Rooms; Pain, Postoperative; Sternum; Thoracotomy
Type
journal article