Less Invasive Cardiac Anesthesia: An Ultra-Fast-Track Procedure Avoiding Thoracic Epidural Analgesia

Authors

  • Peter Jan Brucek
  • Zbynek Straka
  • Tomas Vanek
  • Martin Jares

DOI:

https://doi.org/10.1532/hsf.1183

Abstract

Background and Objective: A new "less invasive" technique avoiding thoracic epidural analgesia has been tested for suitability as a routine procedure for cardiac anesthesia. Early postoperative extubation is an important step in this fast-track procedure.

Materials and Methods: Consecutive patients (n = 547; age, 35-82 years; mean age, 64 years; 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). 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 Discussion: Of 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. Ninety-six (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.

Conclusion: Early 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.

References

Peragallo RA, Cheng DCH. 2000. Tracheal extubation should not occur routinely in the operating room after cardiac surgery. J Cardiothorac Vasc Anesth 14:611-3.nRoyse CF, Royse AG, Soeding PF. 1999. Routine immediate extubation after cardiac operation: a review of our first 100 patients. Ann Thorac Surg 68:1326-9.nVricella LA, Dearani JA, Gundry SR, et al. 2000. Ultra fast track in elective congenital cardiac surgery. Ann Thorac Surg 69:865-71.nDjaiani GN, Ali M, Heinrich L, et al. 2001. Ultra-fast-track technique facilitates operating room extubation in patients undergoing off pump coronary revascularization surgery. J Cardiothorac Vasc Anesth 15:152-7.nLee TWR, Jacobsohn E. 2000. Tracheal extubation should occur routinely in the operating room after cardiac surgery. J Cardiothorac Vasc Anesth 14:603-10.nMontes FR, Sanchez SI, Giraldo JC, et al. 2000. The lack of benefit of tracheal extubation in the operating room after coronary artery bypass surgery. Anesth Analg 91:776-80.nOxelbark S, Bengtsson L, Eggersen M, et al. 2001. Fast track as a routine for open heart surgery. Eur J Cardiothorac Surg 19:460-3.n

Published

2005-02-07

How to Cite

Brucek, P. J., Straka, Z., Vanek, T., & Jares, M. (2005). Less Invasive Cardiac Anesthesia: An Ultra-Fast-Track Procedure Avoiding Thoracic Epidural Analgesia. The Heart Surgery Forum, 6(6), E107-E110. https://doi.org/10.1532/hsf.1183

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Section

Articles