title: Total spinal anesthesia for cardiac surgery: does it make a difference in patient outcomes?
abstract: BACKGROUND
  Heart disease is a major cause of morbidity and mortality. While cardiac surgery is a viable treatment option, it is a potent physiological stressor. The surgical stress response may result in patient decompensation and negative patient outcomes. The goal of a novel anesthetic approach, which combines high spinal anesthesia with intrathecal morphine and general anesthesia (TSA), is to attenuate this stress response.
  
  
  OBJECTIVE
  The primary purpose of this pilot study (n = 70) was to describe and compare the outcomes of TSA cardiac surgery with a matched control sample of patients who received the "standard general anesthetic" (GA).
  
  
  METHODS
  A retrospective, descriptive, correlational design was used for a matched pair total sample of (n = 70). Following ethics approval, patient consents were obtained and chart review data collection was completed.
  
  
  RESULTS
  TSA patients were more likely to be extubated in the operating room (p < 0.0001) and also had significantly shorter overall duration of endotracheal intubation (p < 0.0008). During the initial 24 hours after surgery, the TSA group received significantly less morphine (p < 0.0001). The mean difference in postoperative hospital length of stay did not reach statistical significance. However, on average, the TSA group was discharged three days earlier than the GA group.
  
  
  CONCLUSIONS
  This evidence highlights the clinical nursing relevance of the type of anesthesia on postoperative care and outcomes. The knowledge gained from these findings will help to enable the multidisciplinary critical care team to anticipate TSA patient outcomes and to facilitate the development of appropriate and effective evidence-based, patient-focused plans of care. This pilot study establishes sound rationale for subsequent larger prospective cohort research of the TSA patient population.
authors.affiliation: Cardiac Sciences Program of Manitoba, St. Boniface General Hospital, Winnipeg.
authors.forename: Susan
authors.initials: S
authors.lastname: Mertin
authors.forename: Jo-Ann V
authors.initials: JA
authors.lastname: Sawatzky
authors.forename: William L
authors.initials: WL
authors.lastname: Diehl-Jones
authors.forename: Trevor W R
authors.initials: TW
authors.lastname: Lee