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Fast-Track/Off Pump/Prediction/Outcome

Evaluation of early extubation (fast-track) after cardiac surgery in a post-anaesthesia recovery unit: 026

Matute, P.; Fita, G.; Rovira, I.; Gomar, C.; Peix, N.; Basora, M.; Fontanals, J.; Roux, C.; Sala, X.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 23
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Introduction: The advances in anaesthetics, surgery and extracorporeal techniques have allowed early extubation of patients undergoing cardiac surgery. The goal of this study was to compare the outcome of patients with early extubation in a general post-anaesthesia recovery unit (RR) with patients extubated in a cardiac intensive care unit (ICU).

Method: During 2002, 657 patients were scheduled for cardiac surgery and 109 (16.6%) of them (group I) with fast-track protocol were extubated early in the RR. Group I was compared with a historical case control of 40 patients (6%) (group II) that were managed in the ICU with the same extubation criteria. Data recorded were: time to extubation (TE), ICU + High Dependence Unit and hospital length of stay (ICU/HDU and HS respectively), postoperative complications (PC), number of re-intubations (NR) and deaths. Demographic data, ASA status, type of surgery, type of anaesthesia and time of extracorporeal circulation (ECC) were also recorded. Data are expressed as mean ± SD, Student's t-test and chi-squared test were used for statistical analysis. P < 0.05 was significant.

Results: Results are shown in Table 1. Demographic data were similar. Both groups were similar in ASA status, type of surgery, type of anaesthesia (balanced anaesthesia) and time of ECC. Time from the end of surgery to extubation was significantly shorter in group I (2.1 hr) than in group II (8.8hr). ICU/HDU stay, hospital stay, number of re-intubations and deaths were similar in both groups.

Table 1
Table 1:
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Regarding the postoperative complications, atrial fibrillation was significantly more frequent in group II with 5 patients vs. 0 patients in group I. For termination of atrial fibrillation 2 patients needed cardioversion and 2 patients pharmacological treatment.

Conclusions: In our study the fast-track technique for early extubation is the RR is safe and does not increase postoperative morbidity and mortality, but in this study the fast-track technique does not decrease the ICU/HDU and hospital stay.

References:

1 Lee WR, Jacobson E. Pro: Tracheal extubation should occur routinely in the operating room after cardiac surgery. J Thorac Cardiovasc Anesth 2000; 14: 603-610.
    2 Nicholson DJ, Kowalski SE, Hamilton GA et al. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short-term mechanical ventilation and early extubation. J Thorac Cardiovasc Anesth 2002; 16: 27-31.
      © 2004 European Society of Anaesthesiology