• The heart surgery forum · Jan 2003

    Less invasive cardiac anesthesia: an ultra-fast-track procedure avoiding thoracic epidural analgesia.

    • Peter Jan Brucek, Zbynek Straka, Tomas Vanek, and Martin Jares.
    • Department of Cardiac Surgery, Kralovske Vinohrady University Hospital, Prague, Czech Republic.
    • Heart Surg Forum. 2003 Jan 1;6(6):E107-10.

    Background And ObjectiveA 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 MethodsConsecutive 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 DiscussionOf 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.ConclusionEarly 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.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…