Document Detail


Do shorter-acting neuromuscular blocking drugs or opioids associate with reduced intensive care unit or hospital lengths of stay after coronary artery bypass grafting? CABG Clinical Benchmarking Data Base Participants.
MedLine Citation:
PMID:  9637635     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The authors hypothesized that shorter-acting opioid and neuromuscular blocking drugs would be associated with reductions in duration of intubation, length of stay (LOS) in the intensive care unit (ICU) after tracheal extubation, or postoperative (exclusive of ICU) LOS, and that shorter durations of intubation would be associated with reduced ICU LOS after extubation and postoperative (exclusive of ICU) LOS. METHODS: One-thousand ninety-four patients undergoing primary coronary artery bypass graft surgery at 40 academic health centers were studied. Multiple patient-related factors were included in multivariate models for hypothesis testing. RESULTS: The duration of tracheal intubation, ICU LOS after extubation, and postoperative (exclusive of ICU) LOS all varied significantly by site. There was no difference between vecuronium and pancuronium in duration of intubation, ICU LOS after extubation, or postoperative (exclusive of ICU) LOS. Use of sufentanil rather than fentanyl was associated with a significant (P=0.045) reduction of 1.9 h (95% CI, 0.04 to 4.1 h) in duration of tracheal intubation but had no significant effect on ICU LOS after extubation, total ICU LOS, postoperative (exclusive of ICU) LOS, or total postoperative LOS. The authors' best model predicts a complex association between increasing duration of intubation and both ICU LOS after tracheal extubation and postoperative (exclusive of ICU) LOS, which was associated with an increase in those measures when duration of intubation exceeded 7.3 or 3 h, respectively. CONCLUSIONS: The LOS measures varied considerably among the institutions. Use of shorter-acting opioid and neuromuscular blocking drugs had no association with ICU LOS after tracheal extubation or with postoperative (exclusive of ICU) LOS. Only when the duration of intubation exceeded threshold values was it associated with increased LOS measures.
Authors:
J Butterworth; R James; R C Prielipp; J Cerese; J Livingston; D A Burnett
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  Anesthesiology     Volume:  88     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-07-14     Completed Date:  1998-07-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1437-46     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA. jbutter@bgsm.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Analgesics, Opioid*
Coronary Artery Bypass / economics*,  methods
Cost Control
Female
Humans
Intensive Care Units*
Intubation, Intratracheal
Length of Stay
Male
Middle Aged
Multivariate Analysis
Neuromuscular Blocking Agents*
Postoperative Care
Time Factors
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Neuromuscular Blocking Agents
Comments/Corrections
Comment In:
Anesthesiology. 1998 Jun;88(6):1429-33   [PMID:  9637632 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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