Less invasive cardiac anesthesia: an ultra-fast-track procedure avoiding thoracic epidural analgesia
Language English Country United States Media print
Document type Journal Article
PubMed
14721994
Knihovny.cz E-resources
- MeSH
- Time Factors MeSH
- Anesthesia, General methods MeSH
- Adult MeSH
- Analgesia, Epidural MeSH
- Cardiac Surgical Procedures methods MeSH
- Coronary Artery Bypass MeSH
- Middle Aged MeSH
- Humans MeSH
- Ventilator Weaning MeSH
- Reoperation MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Valves surgery MeSH
- Feasibility Studies MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND AND OBJECTIVE: A new "less invasive" technique avoiding thoracic epidural analgesia has be en tested for suitability as a routine procedure for cardiac anesthesia. Early postoperative extubation is an important step in this fasttrack procedure. MATERIALS AND METHODS: Consecutive patients (n = 547; age, 35-82 years; mean age, 64 year s; male to female ratio, 3.5) underwent general anesthesia with ultra-short-acting opiates and then underwent coronary surgery (n = 465), valve surgery (n = 38), or combined and other procedures (n = 44) a r;. In 51.4% cases, coronary artery bypass grafting was performed off pump. The percentage of patients extubated within 10 minutes after skin closure was the primary end point. In addition, we attempted to identify the limiting factors of the procedure tested. RESULTS AND DISCUSSION: Of the 547 patients, 499 (91%) were extubated within 10 minutes after skin closure. Early extubation failed in 48 (9%) of the patients. The mortality rate was 1.5%. One (0.2%) of the patients needed early reintubation because of pneumothorax. Postoperative myocardial ischemia was recorded in 10 (1.8%) of the patients. Ninetysix (17.5%) of the patients were treated pharmacologically for newly developed atrial fibrillation. None of the patients needed hemodialysis. Transient neurological disorders were recorded in 10 (1.8%) of the patients. The early extubation failure group showed statistically significantly higher rates of preoperative lung dysfunction, use of extracorporeal circulation, administration of inotropic drugs in the operating room, and statistically significantly longer duration of surgery. CONCLUSION: Early extubation proved suitable as a routine procedure for the vast majority of patients. With a good postoperative analgetic protocol, there is no need for thoracic epidural analgesia. Such avoidance of thoracic epidural analgesia is a further step in minimizing invasiveness in cardiac surgery.
