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Anesth Analg 2003;97:601
© 2003 International Anesthesia Research Society

LETTERS TO THE EDITOR

Immediate Extubation After Aortic Valve Surgery Using High Thoracic Epidural Anesthesia: A Pilot Study

Thomas M. Hemmerling, MD DEAA, Jean-Luc Choinière, MD FRCPC, Joanne D. Fortier, MD FRCPC, Ignatio Prieto, MD FRCP(S), and Fadi Basile, MD FRCP(S)

Department of Anesthesiology Department of Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada

To the Editor:

Recently, several studies have presented tracheal extubation in the operating room as a routine procedure after aortocoronary bypass surgery (1–3). We conducted a pilot study that examines the feasibility of immediate extubation after simple or combined aortic valve surgery. Twenty patients undergoing aortic valve surgery with an ejection fraction of more than 30% were included in this prospective audit. After insertion of a high thoracic epidural catheter, induction of anesthesia using fentanyl 2–3 µg/kg, propofol 1–2 mg/kg, and endotracheal intubation facilitated by rocuronium, anesthesia was maintained using sevoflurane titrated according to bispectral index (target index 50). Perioperative analgesia was provided using a high thoracic epidural catheter. Patients underwent simple aortic valve surgery (n = 10) or combined aortic valve surgery (n = 10), with additional coronary artery bypass grafting (n = 6), replacement of the ascending aorta (Bentall, n = 2), repair of an open foramen ovale (n = 1), or replacement of an existing mechanical valve (n = 1). All 20 patients were extubated within 15 min after surgery at a temperature of 36.3°C (0.7) (mean (SD)). There was no need for reintubation, and pain scores were low immediately after surgery, at 6 h, 24 h, and 48 h after surgery at 1.6 (1.2), 1.4 (1.2), 1.6 (1.7), and 1.1 (1.7), respectively. In all patients, thoracic epidural analgesia was discontinued at an INR < 1.5 at 2.5 (0.6) days. Twelve of 20 patients needed temporary pacemaker activation. Immediate extubation seems feasible after aortic valve surgery using high thoracic epidural analgesia.

References

  1. Royse CF, Royse AG, Soeding PF. Routine immediate extubation after cardiac operation: a review of our first 100 patients. Ann Thorac Surg 1999; 68: 1326–9.[Abstract/Free Full Text]
  2. Djaiani GN, Ali M, Heinrich L, et al. Ultra-fast-track anesthetic technique facilitates operating room extubation in patients undergoing off-pump coronary revascularization surgery. J Cardiothorac Vasc Anesth 2001; 15: 152–7.[ISI][Medline]
  3. Straka Z, Brucek P, Vanek T, et al. Routine immediate extubation for off-pump coronary artery bypass grafting without thoracic epidural analgesia. Ann Thorac Surg 2002; 74: 1544–7.[Abstract/Free Full Text]



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J. F. Olivier, N. Le, J. L. Choiniere, I. Prieto, F. Basile, and T. Hemmerling
Comparison of three different epidural solutions in off-pump cardiac surgery: pilot study
Br. J. Anaesth., November 1, 2005; 95(5): 685 - 691.
[Abstract] [Full Text] [PDF]

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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press