DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20184913

Operating room (OR) extubation after off pump coronary artery bypass grafting surgery: its feasibility and effect on post operative complication: a prospective study

Nimish Rai, Tushar Malewar, Nidhi Rai

Abstract


Background: The expansion of coronary surgery on the beating heart without cardiopulmonary bypass has led to increasing interest in ultra-fast track anesthesia, allowing extubation of the patient in the operating room. Ultrafast tracking of anesthesia (UFTA) is practiced routinely, whereas immediate on-table extubation after off-pump coronary artery bypass (OPCAB) grafting surgery has many concerns. The purpose of our study was to evaluate the safety and feasibility of Operating Room (OR) extubation.

Methods: Authors have conducted a study in 158 patients undergone OPCAB. Patients were observed carefully for their intraoperative behavior in terms of hemodynamics, urine output, requirement of inotropes, bleeding and body temperature and then selected for OR extubation. Post-operative complications such as bleeding, reoperation, re-intubation and ventilation, stroke, deep sternal infection and in-hospital mortality were checked. Serial ABG (Arterial Blood Gas) (pO2, pCO2 and O2 saturation) was performed: preoperative, pre-extubation (OR), Intensive Thoracic Unit (ITU) on transfer and ITU 4 hours.

Results: Authors found OR extubation was safely feasible in 151 patients. 4 patients were reintubated and there were 2 in hospital mortality. None had deep sternal infection. The analysis of arterial Blood Gas revealed no significant changes between pre and post-operative values. All hospital survivors were discharged between 6th and 8th postoperative days.

Conclusions: Our results concluded that Operating Room (OR) extubation is feasible in the majority of patients undergoing OPCAB and the technique is safe, effective and does not increase post-operative complications.

Keywords


Artery bypass surgery, Arterial blood gas, Off pump coronary, Operating room extubation, Post-operative complication, Ultra fast track anesthesia

Full Text:

PDF

References


Swaminathan M, Phillips-Bute BG, Patel UD, Shaw AD, Stafford-Smith M, Douglas PS, et al. Increasing healthcare resource utilization after coronary artery bypass graft surgery in the United States. Circulation: Cardiovascular Quality Outcomes. 2009 Jun 16:108.

Hawkes C, Foxcroft DR, Yerrell P. Clinical guideline for nurse‐led early extubation after coronary artery bypass: an evaluation. J Advanced Nursing. 2010 Sep;66(9):2038-49.

Royse CF, Royse AG, Soeding PF. Routine immediate extubation after cardiac operation: a review of our first 100 patients. Ann Thoracic Surg. 1999 Oct 1;68(4):1326-9.

Gangopadhyay S, Acharjee A, Nayak SK, Dawn S, Piplai G, Gupta K. Immediate extubation versus standard postoperative ventilation: Our experience in on pump open heart surgery. Indian J Anaesthesia. 2010 Nov;54(6):525-30.

Oxelbark S, Bengtsson L, Eggersen M, Kopp J, Pedersen J, Sanchez R. Fast track as a routine for open heart surgery. Eur J Cardio-thoracic Surg. 2001 Apr 1;19(4):460-3.

Hemmerling TM, Choinière JL, Fortier JD, Prieto I, Basile F. Immediate extubation after aortic valve surgery using high thoracic epidural anesthesia: a pilot study. Anesth Analg. 2003;97:601.

Hemmerling TM, Prieto I, Choinière JL, Basile F, Fortier JD. Ultra-fast-track anesthesia in off-pump coronary artery bypass grafting: a prospective audit comparing opioid-based anesthesia vs thoracic epiduralbased anesthesia. Canad J Anesthesia. 2004 Feb 1;51(2):163-8

Kandasamy A, Ramalingam SK, Simon HA, Arumugham S, Reddy BD, Krupananda H. Ultra fast-tracking versus a conventional strategy in valve replacement surgery. Indian J Anaesthesia. 2013 May;57(3):298-300.

Dorsa AG, Rossi AI, Thierer J, Lupiañez B, Vrancic JM, Vaccarino GN, et al. Immediate extubation after off-pump coronary artery bypass graft surgery in 1,196 consecutive patients: feasibility, safety and predictors of when not to attempt it. J Cardiothoracic Vascular Anesth. 2011 Jun 1;25(3):431-6.

Edgerton JR, Herbert MA, Prince SL, Horswell JL, Michelson L, Magee MJ, et al. Reduced atrial fibrillation in patients immediately extubated after off-pump coronary artery bypass grafting. Ann Thoracic Surg. 2006 Jun 1;81(6):2121-7.

Borracci RA, Dayán R, Rubio M, Axelrud G, Ochoa G, Rodríguez LD. Operating room extubation (ultra fast-track anesthesia) in patients undergoing on-pump and off-pump cardiac surgery. Arch Cardiol Mexico. 2006;76(4):383-9.

Wong WT, Lai VK, Chee YE, Lee A. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev. 2016 Sep 12;9:CD003587.

Hemmerling TM, Romano G, Terrasini N, Noiseux N. Anesthesia for off-pump coronary artery bypass surgery. Ann Cardiac Anaesth. 2013 Jan 1;16(1):28-39.

Singh KE, Baum VC. Pro: early extubation in the operating room following cardiac surgery in adults. Semin Cardiothorac Vasc Anesth. 2012 Dec;16(4):182-6.