[Early extubation in cardiac surgery].

INTRODUCTION: An early extubation in cardiac surgery (fast track cardiac anaesthesia) refers to mechanical ventilation during 1-6 hours after the intervention, the extubation criteria being the same as for any other surgery. Different protocols have been established for managing patients undergoing fast track anaesthesia, with high-thoracic epidural anaesthesia being increasingly used in the last few years.

MATERIAL AND METHODS: Thirty-five consecutive patients scheduled for OPCAB surgery, who were planned for very fast track cardiac anaesthesia (planned extubation within one hour after the end of the operation), were included in the study. Combined high-thoracic epidural and general anaesthesia was performed in all patients, with bupivacain as a local anaesthetic and inhalational or intravenous anesthetic used for general anaesthesia.

RESULTS: Thirty three of 35 patients (94.3%) were extubated early, with the mean duration of the mechanical ventilation of 56 +/- 92 minutes. Very fast track cardiac anaesthesia was performed successfully in 24/35 (68.8%) patients; these patients had higher ejection fraction, lower Euroscore, shorter duration of the surgery, and fewer numbers of grafts, as compared to the patients extubated early. Euroscore was the only independent predictor of the early extubation (higher score--longer mechanical ventilation time).

DISCUSSION AND CONCLUSION: Our results suggest that high-toracic epidural anaesthesia enables successful early tracheal extubation in the population of patients scheduled for OPCAB cardiac surgery. We had no complications related to this type of anaesthesia and very good perioperative results.