Routine immediate extubation after cardiac operation: a review of our first 100 patients.
BACKGROUND
Early extubation after cardiac operation is an important aspect of fast-track cardiac anesthesia. Immediate extubation is an extension of this concept. We describe a technique that allows immediate extubation in the majority of patients.


METHODS
To allow rapid emergence, anesthesia was modified from a high-dose opioid technique to intravenous propofol anesthesia supplemented with sevoflurane. Normothermic cardiopulmonary bypass was used with routine intermittent antegrade and retrograde tepid blood cardioplegia. High thoracic epidural analgesia was used to facilitate immediate extubation in the majority of patients. Contraindications to immediate extubation were prolonged cardiopulmonary bypass (CPB) (>2.5 hours), hemodynamic instability, uncontrolled bleeding, morbid obesity, severe pulmonary hypertension, congestive cardiac failure, or if the operation was emergent.


RESULTS
Of 109 consecutive patients, 100 were immediately extubated (92%). No patient required reintubation within the first 24 hours after operation. One patient required reintubation 3 days after operation for sputum retention, and 2 patients required reoperation. There was no mortality and the incidence of perioperative morbidity was low.


CONCLUSIONS
Immediate extubation after cardiac operation can be safely achieved and is possible in a majority of patients.
Royse
C F
CF
Department of Anesthesia and Cardiothoracic Surgery, The Royal Melbourne Hospital, Australia. colinroyse@msn.com
Royse
A G
AG
Soeding
P F
PF
D000368:Aged; D015360:Analgesia, Epidural; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D015742:Propofol; D000077149:Sevoflurane; D016896:Treatment Outcome; D015300:Ventilator Weaning
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol