title: Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass.
abstract: BACKGROUND
  With the evolution of anesthesia and surgical procedures, fast track extubation has gained an increased interest, mainly based on the possibility of reducing health costs seemingly without compromising patient care.
  
  
  OBJECTIVE
  To compare two groups of patients submitted to a non-fast track extubation and a fast track extubation protocol after coronary artery bypass graft surgery with cardiopulmonary bypass, regarding their times of ventilation and intubation and their complication rates in the postoperative period.
  
  
  METHODS
  During the year of 1998, 323 sequential patients scheduled for isolated coronary artery bypass graft surgery with cardiopulmonary bypass were enrolled in the study. Fifty-nine patients were excluded due to preoperative use of emergent mechanical and/or inotropic hemodynamic support, low body mass index (< or =18-20 kg/m(2)), reoperations for acute surgical complications, off-pump coronary artery bypass graft surgery, severe respiratory disease, recent myocardial infarction (< or =7 days) and absence of relevant data. Previous myocardial infarction (> or =7 days), prophylactic intraaortic balloon pump and use of postoperative vasoactive drugs were not exclusion criteria. We compared 76 patients sequentially submitted to anesthesia by one of the authors with a fast track extubation protocol and 188 patients sequentially submitted to anesthesia by others in the same period and using a conventional anesthetic protocol.
  
  
  RESULTS
  Demographic data, previous medical and cardiac history, preoperative medication and operative data were all similar between the two groups. The mean ventilation and intubation times were significantly shorter in the fast track extubation group than in the non-fast track extubation patients (30 min vs. 7 h and 50 min vs. 8 h, respectively). Forty-two percent of patients in the fast track extubation group were extubated on arrival at the intensive care unit. Morbidity and mortality were similar in both groups.
  
  
  CONCLUSIONS
  The study shows that a very fast track extubation protocol may be safely implemented in patients submitted to coronary artery bypass graft surgery with cardiopulmonary bypass.
authors.affiliation: Department of Anesthesiology and Emergency, Centro Hospitalar de Vila Nova de Gaia, Rua Conceição Fernandes, Portugal. jreis@chvng.min-saude.pt
authors.forename: J
authors.initials: J
authors.lastname: Reis
authors.forename: J C
authors.initials: JC
authors.lastname: Mota
authors.forename: P
authors.initials: P
authors.lastname: Ponce
authors.forename: A
authors.initials: A
authors.lastname: Costa-Pereira
authors.forename: M
authors.initials: M
authors.lastname: Guerreiro
mesh_terms: D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D012121:Respiration, Artificial; D013997:Time Factors