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Fast-Track/Off Pump/Prediction/Outcome

Efficiency of early extubation in geriatric cardiosurgical patients: 037

Klypa, T. V.; Kozlov, I. A.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 22

Introduction: Fast-track anaesthesia protocols in patients undergoing surgery with cardiopulmonary bypass (CPB) are effective in reducing postoperative complications and decreasing hospital stay [1]. The purpose of this study was to investigate the efficiency of early extubation in geriatric patients after CPB.

Method: The randomized study involved 52 geriatric patients (75-82 years old) divided into 2 groups. Group F included 20 males and 5 females (mean age 76.8 ± 1.6) with a fast-track anaesthesia protocol (low-dose fentanyl, propofol or midazolam, isoflurane, vecuronium) and early extubation. The control group C included 23 males and 4 females (mean age 76.2 ± 1.2) with a prolonged ventilation protocol (high-doses fentanyl, diazepam, ketamine, pancuronium). NYHA physical status of patients was 3.1 ± 0.1 in both groups. Coronary artery bypass grafting was performed in 52% of group F patients, and in 55.5% of group C patients, 1-2 valves replacements were performed in 48% and 44.5% of groups, respectively. Statistical significance was calculated using Student's t-test.

Results: Our investigation demonstrated a decrease in some postoperative cardiovascular, pulmonary and cerebral complications in group F. The length of stay in intensive care unit in patients older 75 years with early extubation was shorter. There was no difference in postoperative hospital stay in groups (table).

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Discussion: Fast-track anaesthesia protocols as used in many clinics for patients undergoing surgery and CPB lead to a decrease in hospital stay. Elderly patients have more co-morbid conditions, yet a significant number can be extubated early, with a resulting shorter length of stay in hospital [1;2]. Our investigation demonstrated a decrease in some postoperative complication and mean length of stay in intensive care unit in patients 75 years or older with early extubation, but with no difference in postoperative hospital stay.

Conclusion: This study confirms the safety and efficacy of early extubation among elderly patients operated with CPB.

Reference:

1 Oxelbark S, Bengtsson L, Eggersen M, et al. Fast track as a routine for open heart surgery. Eur J Cardiothorac Surg 2001; 19: 460-463.
© 2004 European Society of Anaesthesiology