| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2002;74:1544-1547
© 2002 The Society of Thoracic Surgeons
a Department of Cardiac Surgery, Kralovske Vinohrady University Hospital, 3rd Medical School of Charles University, Prague, Czech Republic
b Department of Cardiology, Kralovske Vinohrady University Hospital, 3rd Medical School of Charles University, Prague, Czech Republic
Accepted for publication June 20, 2002.
* Address reprint requests to Dr Straka, Department of Cardiac Surgery, Kralovske Vinohrady University Hospital, Srobarova 50, 100 34 Prague, Czech Republic.
e-mail: straka{at}fnkv.cz
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-short-acting 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 µg · kg-1 · 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.
This article has been cited by other articles:
|
|
 |
|
  J. Poelaert, P. Depuydt, A. De Wolf, S. Van de Velde, I. Herck, and S. Blot Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: A pilot study. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 771 - 776. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. M. Dewey and M. J. Mack Myocardial Revascularization without Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2008; 3(2008): 633 - 654. [Full Text]
|
|
|
|
 |
|
 J. R. Edgerton, M. A. Herbert, S. L. Prince, J. L. Horswell, L. Michelson, M. J. Magee, T. M. Dewey, Z. J. Edgerton, and M. J. Mack Reduced Atrial Fibrillation in Patients Immediately Extubated After Off-Pump Coronary Artery Bypass Grafting Ann. Thorac. Surg., June 1, 2006; 81(6): 2121 - 2127. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. W. Khalil, A. Chaterjee, G. MacBryde, P. K. Sarkar, and R. R. D. Marks Single dose parecoxib significantly improves ventilatory function in early extubation coronary artery bypass surgery: a prospective randomized double blind placebo controlled trial Br. J. Anaesth., February 1, 2006; 96(2): 171 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Chaney Intrathecal and Epidural Anesthesia and Analgesia for Cardiac Surgery Anesth. Analg., January 1, 2006; 102(1): 45 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Vanek, M. Jares, R. Fajt, Z. Straka, K. Jirasek, M. Kolesar, P. Brucek, and M. Maly Fibrinolytic inhibitors in off-pump coronary surgery: a prospective, randomized, double-blind TAP study (tranexamic acid, aprotinin, placebo) Eur. J. Cardiothorac. Surg., October 1, 2005; 28(4): 563 - 568. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. B. Hammer, C. Ramamoorthy, H. Cao, G. D. Williams, M. G. Boltz, K. Kamra, and D. R. Drover Postoperative Analgesia After Spinal Blockade in Infants and Children Undergoing Cardiac Surgery Anesth. Analg., May 1, 2005; 100(5): 1283 - 1288. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Barrington, R. Kluger, R. Watson, D. A. Scott, and K. J. Harris Epidural Anesthesia for Coronary Artery Bypass Surgery Compared with General Anesthesia Alone Does Not Reduce Biochemical Markers of Myocardial Damage Anesth. Analg., April 1, 2005; 100(4): 921 - 928. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. H. Cheng Regional analgesia and ultra-fast-track cardiac anesthesia/Analgesie regionale et procedure ultra-acceleree d'anesthesie cardiaque Can J Anesth, January 1, 2005; 52(1): 12 - 17. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Widimsky, Z. Straka, P. Stros, K. Jirasek, J. Dvorak, J. Votava, L. Lisa, T. Budesinsky, M. Kolesar, T. Vanek, et al. One-Year Coronary Bypass Graft Patency: A Randomized Comparison Between Off-Pump and On-Pump Surgery Angiographic Results of the PRAGUE-4 Trial Circulation, November 30, 2004; 110(22): 3418 - 3423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Srinivasan, A. D. Grayson, and B. M. Fabri On-Pump Versus Off-Pump Coronary Artery Bypass Grafting in Diabetic Patients: A Propensity Score Analysis Ann. Thorac. Surg., November 1, 2004; 78(5): 1604 - 1609. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Weissman Pulmonary Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 185 - 211. [Abstract] [PDF]
|
|
|
|
|
|
Z. Straka, P. Widimsky, K. Jirasek, P. Stros, J. Votava, T. Vanek, P. Brucek, M. Kolesar, and R. Spacek Off-pump versus on-pump coronary surgery: final results from a prospective randomized study Prague-4 Ann. Thorac. Surg., March 1, 2004; 77(3): 789 - 793. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Hemmerling, I. Prieto, J.-L. Choiniere, F. Basile, and J. D. Fortier Ultra-fast-track anesthesia in off-pump coronary artery bypass grafting: a prospective audit comparing opioid-based anesthesia vs thoracic epidural-based anesthesia: [Un mode anesthesique ultrarapide pendant le pontage aortocoronarien a coeur battant : un audit prospectif comparant l'anesthesie avec opioides et l'anesthesie peridurale thoracique] Can J Anesth, February 1, 2004; 51(2): 163 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Ngaage Off-pump coronary artery bypass grafting: the myth, the logic and the science Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 557 - 570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Hemmerling, J.-L. Choiniere, J. D. Fortier, I. Prieto, and F. Basile Immediate Extubation After Aortic Valve Surgery Using High Thoracic Epidural Anesthesia: A Pilot Study Anesth. Analg., August 1, 2003; 97(2): 601 - 601. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
