Document Detail

Routine immediate extubation for off-pump coronary artery bypass grafting without thoracic epidural analgesia.
MedLine Citation:
PMID:  12440606     Owner:  NLM     Status:  MEDLINE    
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 theater. The techniques described to date combined general anesthesia with thoracic epidural analgesia. We report the routine application of a technique that allows immediate extubation in the majority of patients undergoing off-pump coronary artery bypass grafting without thoracic epidural analgesia. METHODS: Fast-track anesthesia using an ultra-shortacting opiate remifentanil, without epidural catheter insertion, was used in 160 unselected patients undergoing off-pump coronary artery bypass grafting (aged 43 to 83 years, mean 65 years). There were an average of 2.2 bypass procedures per patient, with the left internal mammary artery used in 93%. Contraindications to immediate extubation were (except for failure to meet standard extubation criteria) hemodynamic instability and persistent bleeding at the end of operation. Satisfactory postoperative pain control was achieved by continuous remifentanil (0.0125 to 0.05 microg x kg(-1) x min(-1)). RESULTS: Operating theater extubation within 10 minutes of the end of operation was feasible in 150 patients (94%). Five patients (3%) were extubated within 2 hours, and the remaining 5 patients (3%) were converted to standard anesthesia. There were no deaths during hospitalization. Major complications included myocardial infarction and transient ischemic attacks (2 patients each). No pulmonary complications were seen. Episodes of atrial fibrillation occurred in 21% of the patients undergoing operation. CONCLUSIONS: Immediate extubation is possible in most patients after off-pump coronary artery bypass grafting even without thoracic epidural analgesia. We believe this type of less invasive cardiac anesthesia is safe and promising.
Zbynek Straka; Petr Brucek; Tomas Vanek; Jan Votava; Petr Widimsky
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  74     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-11-20     Completed Date:  2002-12-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1544-7     Citation Subset:  AIM; IM    
Department of Cardiac Surgery, Kralovske Vinohrady University Hospital, Prague, Czech Republic.
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MeSH Terms
Aged, 80 and over
Analgesia, Epidural*
Anesthesia Recovery Period*
Anesthetics, Intravenous*
Cardiopulmonary Bypass*
Coronary Artery Bypass*
Coronary Disease / mortality,  surgery*
Feasibility Studies
Hospital Mortality
Intubation, Intratracheal*
Middle Aged
Outcome and Process Assessment (Health Care)
Survival Rate
Time and Motion Studies
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Piperidines; 132875-61-7/remifentanil

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

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