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CRITICAL CARE AND TRAUMA

The Safety of Immediate Extubation After Abdominal Aortic Surgery: A Prospective, Randomized Trial

Jonathan Cohen, FCP (SA)^*, Jacob Loewinger, MD, Karina Hutin, MD, Jacqueline Sulkes, PhD, Avigdor Zelikovski, MD, and Pierre Singer, MD^*

Departments of *General Intensive Care, Anesthesiology, Epidemiology, and General Vascular Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Address correspondence and reprint requests to Dr. J. Cohen, Department of General Intensive Care, Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel.

We performed this study to assess the safety of immediate extubation after elective abdominal aortic aneurysm surgery. Consecutive patients were prospectively randomized into two groups after surgery: Group 1 (n = 29) immediate extubation; and Group 2 (n = 21) delayed (at least 4 h) extubation. All patients were assessed by a senior anesthesiologist or intensivist before extubation. The following data were collected: preoperative—demographics, presence of comorbid disease, body mass index, hemoglobin level, heart rate, and blood pressure; intraoperative—duration of surgery and cross-clamping, blood loss, amount of crystalloids, colloids, and blood transfused, temperature at end of procedure, urine output, and complications; and postoperative—time to extubation, scores on the Acute Physiology and Chronic Health Evaluation-II and Therapeutic Intervention Scoring System, total fentanyl dose, and complications. Outcome variables were length of intensive care unit and hospital stay and 28-day mortality. The results showed no significant differences in preoperative or intraoperative variables between the groups, apart from a longer duration of surgery in Group 1 (P = 0.045). Group 2 patients had a significantly higher Therapeutic Intervention Scoring System score (P = 0.04) and required a significantly larger dose of fentanyl (P < 0.001). One patient in Group 2 required reintubation after a cerebrovascular accident. The overall mortality rate was 4% (2 patients in Group 2). There were no significant differences in any of the outcome variables. We conclude that immediate extubation can safely be performed after elective abdominal aortic aneurysm surgery.

IMPLICATIONS: In this prospective randomized study, we compared the outcome of patients undergoing elective aortic abdominal surgery who either were extubated immediately after surgery or after 4 h of stabilization in the intensive care unit. No significant differences were found in the length of intensive care unit or hospital stay, or 28-day mortality between the 2 groups.