title: Change in anaesthesia practice and postoperative sedation shortens ICU and hospital length of stay following coronary artery bypass surgery.
abstract: We randomized prospectively 144 patients, undergoing elective coronary artery bypass surgery, to either early or to routine extubation [mechanical ventilatory support for 4-7 h (Group A), or 8-14 h (Group B)]. Anaesthesia was modified for both groups. The groups were well matched in terms of sex, age, NYHA class, preoperative left ventricular ejection fraction, bypass time and aortic cross-clamp time, number of grafts used, and blood units transfused. All patients had normal preoperative respiratory, renal, hepatic and cerebral functions. Mechanical ventilatory support (mean +/- SD) was 6.3 +/- 0.7 h for Group A and 11.6 +/- 1.3 h for Group B. Mean ICU stay was 17 +/- 1.3 h for Group A and 22 +/- 1.2 h for Group B, while the mean hospital stay was 7.3 +/- 0.8 days and 8.4 +/- 0.9, respectively. There were no statistically significant differences in the frequency of all postoperative complications among the two groups. There were no reintubation, readmission to the ICU or death in either group. We concluded that change in anaesthesia practice and early postoperative sedation in patients undergoing elective coronary artery bypass graft (CABG) surgery resulted in earlier tracheal extubation, shorter ICU and hospital length of stay without organ dysfunction or postoperative complications. Early extubation was only possible due to the modification of anaesthesia and ICU sedation regime.
authors.affiliation: Surgical Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Michalopoulos
authors.forename: A
authors.initials: A
authors.lastname: Nikolaides
authors.forename: C
authors.initials: C
authors.lastname: Antzaka
authors.forename: M
authors.initials: M
authors.lastname: Deliyanni
authors.forename: A
authors.initials: A
authors.lastname: Smirli
authors.forename: S
authors.initials: S
authors.lastname: Geroulanos
authors.forename: L
authors.initials: L
authors.lastname: Papadimitriou
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D001026:Coronary Artery Bypass; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D012121:Respiration, Artificial