Nagre Amarja Sachin, Jambures Nagesh P
Department of Cardiac Anaesthesia, MGM Medical College and MCRI, Aurangabad, Maharashtra, India.
Ann Card Anaesth. 2018 Apr-Jun;21(2):129-133. doi: 10.4103/aca.ACA_135_17.
Ultrafast tracking of anesthesia (UFTA) is practiced routinely, whereas immediate on-table extubation after off-pump coronary artery bypass (OPCAB) grafting surgery has many concerns. The purpose of our study was to evaluate the safety and feasibility of immediate extubation (IE) versus UFTA.
Sixty patients were enrolled who underwent OPCAB surgery. The two groups IE and UFTA had thirty patients each. Inclusion criteria were patients for OPCAB surgery including left main stenosis. Exclusion criteria were patients with Ejection Fraction(EF) <30%, with unstable hemodynamics, on intra-aortic balloon pump (IABP), with renal dysfunction, with associated valvular heart diseases, on inotropes, on temporary pacemaker, with intraoperative conversion to on-pump coronary artery bypass grafting (CABG), who are chronic smokers, and with chronic obstructive pulmonary disease. Statistical analysis was done with Minitab 15 software. Descriptive statistics were summarized as mean, standard deviation, and percentage. Student's t-test was used to determine the significance of normally distributed parametric values. Z-test was used for proportion. Statistical significance was accepted at P < 0.05.
OT extubation was found to be safe as no patient had reintubation or respiratory insufficiency. None of the patients in either group had postoperative myocardial infarction, stroke, low cardiac output, mediastinitis, and renal failure. Hypothermia, blood transfusion, atrial fibrillation, and re-exploration did not occur. Intensive Care Unit length of stay was similar in the two groups. Discharge day is statistically significant (P = 0.001), with 5.66 days in the IE group and 6.36 days in the UFTA group. Time spent in the operating room at the end of surgery is statistically significant, with 14.03 min in UFTA group and 33.9 min in IE group.
IE appears to be safe and effective in OPCAB patients without any major complications. It can be achieved after fulfilling traditional extubation criteria but is confined to highly selective group of patients.
麻醉的超快追踪（UFTA）是常规操作，而不停跳冠状动脉搭桥（OPCAB）手术术后即刻拔管存在诸多问题。我们研究的目的是评估即刻拔管（IE）与UFTA的安全性和可行性。
纳入60例行OPCAB手术的患者。IE组和UFTA组各30例患者。纳入标准为行OPCAB手术包括左主干狭窄的患者。排除标准为射血分数（EF）<30%、血流动力学不稳定、使用主动脉内球囊反搏（IABP）、肾功能不全、合并瓣膜性心脏病、使用血管活性药物、使用临时起搏器、术中转为体外循环冠状动脉搭桥术（CABG）、慢性吸烟者以及患有慢性阻塞性肺疾病的患者。使用Minitab 15软件进行统计分析。描述性统计结果以均值、标准差和百分比表示。采用学生t检验确定正态分布参数值的显著性。采用Z检验分析比例。P<0.05时认为具有统计学显著性。
发现手术室拔管是安全的，因为没有患者需要再次插管或出现呼吸功能不全。两组患者均未发生术后心肌梗死、中风、低心排血量、纵隔炎和肾衰竭。未出现体温过低、输血、房颤和再次手术探查情况。两组患者在重症监护病房的住院时间相似。出院日具有统计学显著性（P = 0.001），IE组为5.66天，UFTA组为6.36天。手术结束时在手术室的停留时间具有统计学显著性，UFTA组为14.03分钟，IE组为33.9分钟。
对于OPCAB患者，IE似乎是安全有效的，且无任何重大并发症。在满足传统拔管标准后即可实现，但仅限于高度选择性的患者群体。
