Feasibility of On-table Extubation After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial
| Autor: | Alireza Alizadeh Ghavidel, Bahador Baharestani, Mohammad Hassan Ghaffarinejad, Ziae Totonchi, Azin Alizadehasl, Rasoul Azarfarin, Farideh Mohammadi Alasti, Louise Jafari |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Cardiac Surgery Monitoring 030204 cardiovascular system & hematology law.invention Sufentanil 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Heart rate Cardiopulmonary bypass Medicine Anesthesia 030212 general & internal medicine Cardiopulmonary Bypass business.industry Early Extubation Cardiac surgery Anesthesiology and Pain Medicine Muscle relaxation Blood pressure Bispectral index business medicine.drug Research Article |
| Zdroj: | Anesthesiology and Pain Medicine |
| ISSN: | 2228-7531 2228-7523 |
| Popis: | Background The use of short-acting anesthetics, muscle relaxation, and anesthesia depth monitoring allows maintaining sufficient anesthesia depth, fast recovery, and extubation of the patients in the operating room (OR). We evaluated the feasibility of extubation in the OR in cardiac surgery. Methods This clinical trial was performed on 100 adult patients who underwent elective noncomplex cardiac surgery using cardiopulmonary bypass. Additional to the routine monitoring, the patients' depth of anesthesia and neuromuscular blocked were assessed by bispectral index and nerve stimulator, respectively. In the on-table extubation (OTE) group (n = 50), a limited dose of sufentanil (0.15 µg/kg/h) and inhalational anesthetics were used for early waking. In the control group (n = 50), the same anesthesia-inducing drugs were used but the dose of sufentanil during the operation was 0.7 - 0.8 µg/kg/h. After the operation, cardiorespiratory parameters and ICU stay were documented. Results Demographic and clinical variables were comparable in both study groups. In the OTE group, we failed to extubate two patients in the OR (success rate of 96%). There were no significant differences between the two groups in terms of systolic and diastolic blood pressure at the time of entering the ICU (P > 0.05). Heart rate was lower in the OTE than in the control group at ICU admission (89.4 ± 13.1 vs. 97.6 ± 12.0 bpm; P = 0.008). The ICU stay time was lower in the OTE group (34 (21.5 - 44) vs. 48 (44 - 60) h; P = 0.001). Conclusions Combined inhalational-intravenous anesthesia along with using multiple anesthesia monitoring systems allows reducing the dose of total anesthetics and maintaining adequate anesthesia depth during noncomplex cardiac surgery with cardiopulmonary bypass. Thus, extubation of the trachea in the OR is feasible in these patients. |
| Databáze: | OpenAIRE |
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