To ventilate or not after minimally invasive direct coronary artery bypass surgery: The role of epidural anesthesia

• Published in: Journal of cardiothoracic and vascular anesthesia 2002-02, Vol.16 (1), p.21-26
• Main Authors: de Vries, Adrianus J., Mariani, Massimo A., van der Maaten, Joost M.A.A., Loef, Bert G., Lip, Harm
• Format: Article
• Language: English
• Subjects: Anesthesia, Epidural; Anesthesia, General; Biological and medical sciences; Blood Pressure; Cardiac Output; cardiac surgery; Coronary Artery Bypass; Device Removal; early extubation; epidural anesthesia; Female; Heart Rate; Humans; Intubation, Intratracheal; Length of Stay; Male; Medical sciences; MIDCAB; Middle Aged; Minimally Invasive Surgical Procedures; Pain, Postoperative - drug therapy; Postoperative Care; Postoperative Complications; Respiration, Artificial; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; ventilation
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/jcan.2002.29645

Objective: To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia. Design: Randomized prospective study. Setting: University hospital, single institution. Participants: Patients (n = 90) scheduled for elective MIDCAB surgery. Interventions: Patients were divided into 3 groups: 30 patients had general anesthesia and were extubated immediately after surgery (extubated group), 30 patients had a thoracic epidural and general anesthesia and were extubated immediately after surgery (epidural group), and 30 patients had general anesthesia and were ventilated after surgery (intubated group). Measurements and Main Results: With a similar cardiac index and less vasoactive medication, mean arterial blood pressure (77 ± 8 mmHg [mean ± SD]) and heart rate (76 ± 10 beats/min) in the epidural group were lower on the first postoperative day than in the intubated group (83 ± 10 mmHg and 81 ± 13 beats/min) and the extubated group (86 ± 10 mmHg and 83±13) (p = 0.01 and p = 0.09). Oxygenation on the first postoperative day was better in the epidural group than in the intubated group (14.8 ± 3.8 kPa v 12.6 ± 3.2 kPa; p = 0.05). The epidural group and the extubated group had a transient respiratory acidosis postoperatively. Pain score in the epidural group was lower on the first postoperative day than in the extubated group with general anesthesia (3.0 ± 1.6 visual analog scale v 4.6 ± 1.8 visual analog scale; p = 0.01). Hospital stay was shorter in the epidural group than in the ventilated group (5.9 ± 2.4 days v 8.1 ± 5.3 days; p = 0.05) Conclusion: Immediate postoperative extubation in patients with thoracic epidural anesthesia and supplemental general anesthesia provides the most favorable clinical circumstances after MIDCAB surgery. Copyright 2002, Elsevier Science (USA). All rights reserved.