Letters To The Editor: Letters & Announcements
We highly appreciate the interesting comments made to our article (1). This also gives us an opportunity to clarify some aspects of our study. We do not routinely use forced air warmers after termination of cardiopulmonary bypass and although the hypothermia could be a reason for reintubation, we believe that this was not the case because the temperature was monitored closely during the study. We can not quantify the probable contribution of opioid-based analgesia to the reintubation rate, but we believe the dose used (fentanyl 20–30 μg/h) was too small to be responsible. The utilization of other nonopioid drugs or techniques for analgesia and sedation could be a good alternative in decreasing the rate of reintubation (2); we have no experience using epidural analgesia in patients who will subsequently undergo full or partial systemic heparinization and in fact, a large number of our patients come to the operating room receiving heparin drip.
Although we cannot prove any benefit of immediate versus very early extubation, we were also unable to demonstrate any significant problems with the extubation in the operating room because there was not a statistically significant increase in adverse events. Our article implies that reintubation does not have a deleterious effect in the general status of the patient, and it is not associated with an unfavorable outcome should expert personnel perform such a procedure.
FelixRamon Montes, MD
1. Montes FR, Sanchez SI, Giraldo JC, et al. The lack of benefit of tracheal extubation in the operating room after coronary artery bypass surgery. Anesth Analg 2000; 91: 776–80.
2. Joachimsson PO, Nystrom SO, Tyden FL. Early extubation after coronary artery bypass surgery in sufficiently re-warmed patients: a prospective comparison of opioid anesthesia versus inhalational anesthesia and thoracic epidural anesthesia. J Cardiothorac Anesth 1989; 3: 444–54.