Effect of Immediate Versus Delayed Tracheal Extubation on Incidence of Postoperative Myocardial Ischemia in Adult Cardiac Surgical Patients
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- Category: Vol. 83, September 2015
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Effect of Immediate Versus Delayed Tracheal Extubation on Incidence of Postoperative Myocardial Ischemia in Adult Cardiac Surgical Patients, HODA SAAD, MAGED SALAH, HISHAM HOSNY and MOATAZ SALAH
Abstract
Background: Immediate extubation aims at extubation of cardiac surgical patients at the end of the operation. It has not been found to increase postoperative cardiorespiratory mor-bidity, sympathoadrenal stress, or mortality. On the other hand, it significantly reduces costs and improves resource utilization.
Methods: Fifty two consecutive patients underwent open heart surgeries and were managed by the same anesthesiologist. All adult patients undergoing elective cardiac operations were included in the study. They were divided into 2 groups, 26 patients each, UFTA group and conventional group. Patients were given intravenous midazolam, before surgery as a pre-medication. Induction was achieved using midazolam, fentanyl, and propofol. Tracheal intubation was facilitated by atracurium. Maintenance of anesthesia was achieved using sevoflurane, and a continuous intravenous infusion of morphine. Postop-eratively, patients received intravenous morphine infusion, intravenous morphine on demand, and intravenous paracetamol every 6 hours. Pain was assessed with Visual Analogue Scale (VAS), every 6 hours for the first 24 hours of their ICU stay.
Results: There was a significant reduction in mean length of ICU stay between the UFTA and the conventional groups, 57.42 hours and 95.04 hours respectively. As for postoperative complications, there was no significant difference between the 2 groups, except for postoperative bleeding, postoperative nausea and vomiting, and incidence of ischemia.
Conclusion: The implementation of UFTA protocol led to a significant reduction in the length of ICU stay of adult patients undergoing elective cardiac surgical operations, without increasing postoperative complications.