Gangopadhyay Srikanta, Acharjee Amita, Nayak Sushil Kumar, Dawn Satrajit, Piplai Gautam, Gupta Krishna
Asansol Subdivisional Hospital, Asansol, West Bengal, India.
Indian J Anaesth. 2010 Nov;54(6):525-30. doi: 10.4103/0019-5049.72641.
Elective postoperative ventilation in patients undergoing "on pump" open heart surgery has been a standard practice. Ultra fast-track extubation in the operating room is now an accepted technique for "off pump" coronary artery bypass grafting. We tried to incorporate these experiences in on pump open heart surgery and compare the haemodynamic and respiratory parameters in the immediate postoperative period, in patients on standard postoperative ventilation for 8-12 hours. After ethical committee's approval and informed consent were obtained, 72 patients, between 28 and 45 years of age, undergoing on pump open heart surgery, were selected for our study. We followed same standard anaesthetic, cardiopulmonary bypass (CPB) and cardioplegic protocol. Thirty-six patients (Group E) were randomly allocated for immediate extubation following operation, after fulfillment of standard extubation criteria. Those who failed to meet these criteria were not extubated and were excluded from the study. The remaining 36 patients (Group V) were electively ventilated and extubated after 8-12 hours. Standard monitoring for on pump open heart surgery, including bispectral index was done. The demographic data, surgical procedures, preoperative parameters, aortic cross clamp and cardiopulmonary bypass times were comparable in both the groups. Extubation was possible in more than 88% of cases (n=32 out of 36 cases) in Group E and none required reintubation for respiratory insufficiency. Respiratory, haemodynamic parameters and postoperative complications were comparable in both the groups in the postoperative period. Therefore, we can safely conclude that immediate extubation in the operating room after on pump open heart surgery is an alternative acceptable method to avoid postoperative ventilation and its related complications in selected patients.
在接受“体外循环”心脏直视手术的患者中，术后选择性通气一直是标准做法。目前，手术室中的超快通道拔管是“非体外循环”冠状动脉搭桥术的一种公认技术。我们试图将这些经验应用于体外循环心脏直视手术，并比较术后立即接受8 - 12小时标准术后通气的患者的血流动力学和呼吸参数。在获得伦理委员会批准并取得知情同意后，我们选择了72名年龄在28至45岁之间、接受体外循环心脏直视手术的患者进行研究。我们遵循相同的标准麻醉、体外循环（CPB）和心脏停搏方案。36名患者（E组）在满足标准拔管标准后，于术后立即被随机分配进行拔管。那些未达到这些标准的患者未进行拔管，并被排除在研究之外。其余36名患者（V组）进行选择性通气，并在8 - 12小时后拔管。进行了包括脑电双频指数在内的体外循环心脏直视手术的标准监测。两组患者的人口统计学数据、手术过程、术前参数、主动脉阻断和体外循环时间具有可比性。E组超过88%的病例（36例中的32例）可以进行拔管，且无一例因呼吸功能不全需要重新插管。两组患者在术后的呼吸、血流动力学参数和术后并发症具有可比性。因此，我们可以安全地得出结论，体外循环心脏直视手术后在手术室立即拔管是一种可接受的替代方法，可避免在选定患者中进行术后通气及其相关并发症。
