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
- 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]
- 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.[Web of Science][Medline]
- 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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[Abstract]
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