Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass

Reis, Jorge; Mota, João Carlos; Ponce, Paulo; Costa‐Pereira, Altamiro; Guerreiro, Marilisa M.

doi:10.1016/s1010-7940(02)00121-5

Cited by 65 publications

(59 citation statements)

References 21 publications

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“…27,28 Fentanyl at a dose of 10 to15 μg/kg at induction is commonly used in many centers. 2,16,17,28,24,26,30 Remifentanil was equally safe and effective as fentanyl with no difference in time to extubation. 21 We have maintained anaesthesia with propofol, isoflurane combination in the pre by-pass period.…”

Section: Methods Of Ftcamentioning

confidence: 93%

“…We have included combination of low dose propofol, ketamine, midazolam as induction agent, fentanyl as opioid and vecuronium as muscle relaxant. The most common induction agent is propofol in combination with an opioid, usually at a dose of 0.5 mg/kg with 10mg boluses until loss of consciousness 17,21,22,23,24 although some use propofol in higher doses 2,5,25 or even start directly with an infusion. 26 Etomidate, thiopentone and ketamine are described as being used.…”

Section: Methods Of Ftcamentioning

confidence: 99%

“…1 However, fast track extubation protocols are becoming increasingly popular mainly due to a greater rationalization of resource utilization, lowering hospital costs without increasing morbidity and mortality of the patients. 2 Fast-track cardiac anaesthesia (FTCA) is defined as a perioperative anaesthetic management that aims to facilitate tracheal extubation of patients within one to six hours of cardiac surgery. 3 In this study we retrospectively reviewed the time to extubation and suitability of existing anaesthetic technique for fast-track extubation in patients undergoing cardiac surgical procedures under cardiopulmonary bypass in a tertiary care cardiac centre.…”

Section: Introductionmentioning

confidence: 99%

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Fast-Track Cardiac Anaesthesia at a Tertiary Care Cardiac Centre in Nepal

et al. 2014

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Section: Methods Of Ftcamentioning

confidence: 93%

Section: Methods Of Ftcamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fast-Track Cardiac Anaesthesia at a Tertiary Care Cardiac Centre in Nepal

et al. 2014

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“…Early extubation plays a significant role in FTCA Potential benefits of early extubation include the rapid normalization of ciliary function, an earlier ability to cough, a reduction in the risk of atelectasis, and the correction of intrapulmonary shunt fraction. Cheng et al [4] and Reis et al [5] reported on the safety and efficacy of early extubation. The most important step is the use of minimal doses of (or the titration of) short-acting opioids with inhalation anesthetic agents.…”

Section: Discussionmentioning

confidence: 99%

The management of fast-track cardiac anesthesia in a patient with right atrial myxoma

Gökçe¹

2012

Turk Gogus Kalp Dama

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Primer kalp tümörlerinin insidansı düşük olup, tüm kalp ameliyatlarının yalnızca %0.3'ünü oluştururlar. Atriyal miksomalar primer kalp tümörlerinin en sık görülen tipidir ve bunlar hızlı büyüdüklerinde yaşamı tehdit eden semptomlar gelişebilir. Pulmoner emboli ve infektif endokardit, sağ atriyal miksomanın nadir komplikasyonudur. Bu yazıda pulmoner emboli ve infektif endokardit ile komplike olmuş sağ atriyal miksomalı hastaya minimal invaziv koroner arter baypas greft cerrahisi sırasında uygulanan hızlı derlenme kardiyak anestezisi işlemi ve anestezi yönetimi sunuldu.Anah tar söz cük ler: Atriyal miksoma; hızlı derlenme kardiyak anestezi; enfektif endokardit; pulmoner emboli.The incidence of primary cardiac tumors is low, accounting for only 0.3% of all open cardiac operations. Atrial myxomas are the most common type of primary cardiac tumors, and they may progress to life-threatening symptoms when they enlarge rapidly. Both pulmonary embolism and infective endocarditis are rare complications of right atrial myxomas. In this article, we report the anesthetic management of a patient with right atrial myxoma complicated by pulmonary embolism and infective endocarditis who was treated surgically with a fast-track cardiac anesthesia procedure during minimally invasive coronary artery bypass graft surgery.Key words: Atrial myxoma; fast-track cardiac anesthesia; infective endocarditis; pulmonary embolism.Atrial myxoma is the most frequent cardiac benign tumor and is present in approximately 0.0017%-0.33% of autopsy series. Right atrial myxomas are rare and occur three to four times less frequently than left atrial myxomas. [1] Pulmonary embolism and infective endocarditis are two rare complications of right atrial myxomas. The literature contains only a few reports concerning these complications and their anesthetic management. [1,2] In our case report, we discuss a patient who had right atrial myxoma complicated by pulmonary embolism and infective endocarditis. He was treated surgically with a fast-track cardiac anesthesia (FTCA) protocol. CASE REPORTA 39-year-old man presented with a one-week history of chest pain, fever, and bloody sputum. His heart rate (HR) was 110 beats/min, his oxygen saturation (SpO2) level was 92%, and his temperature was 38° Celsius. Breathing sounds were not heard in the left lower part of the lung, and there was a diastolic murmur on the right side of the sternum. Pulmonary embolism was confirmed by thoracic computed tomography (CT) (Figure 1). At first, an anticoagulation therapy of enoxaparin sodium 2x 0.8 subcutaneously (sc) and coumadin 5 mg peroral (po) was given, but only the enoxaparin sodium 2x 0.8 was continued for three days until the operation was performed.

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“…14 The rapid postoperative rehabilitation procedure that is mandatory for the success of fast-track management (early ambulation after tracheal extubation, followed by transfer to the ward within several hours and full mobilization on the same day) 9 requires optimal pain management. For fast-tracking, administration of opioids, the mainstay of postoperative analgesia, via the standard iv or patient-controlled route 15,16 is unfeasible.…”

Section: Discussionmentioning

confidence: 99%

Early oral analgesia after fast-track cardiac anesthesia

Kogan

Medalion

Raanani

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: Oral analgesia after "fast-track" cardiac anesthesia has not been explored. The aim of this study was to compare two oral oxycodone analgesic regimens. Methods:One hundred-twenty patients scheduled for coronary artery bypass grafting were randomly assigned postoperatively to receive immediate-release oxycodone 5 mg and acetaminophen 325 mg (Percocet-5) (group I) per os four times daily, or controlled-release oxycodone 10 mg (OxyContin) (group II) per os every 12 hr and placebo twice daily. Acetaminophen 500 mg per os was used as first-line rescue medication, and immediate-release oxycodone (syrup form) 5 mg per os as second-line rescue medication. Pain intensity was assessed with a visual analogue scale on the first postoperative day, the morning after extubation, and thereafter four times daily for four days. Use of rescue medication and adverse events were recorded.Results: Baseline demographic and operation-related characteristics were similar in both groups. While pain control was good in both groups, the immediate-release group experienced less pain on all postoperative days (P = 0.003), required significantly less rescue medication, and had fewer adverse effects such as somnolence and nausea. Conclusion:Peroral oxycodone is effective for early pain control after fast-track cardiac anesthesia. Immediate-release oxycodone/acetaminophen appears to provide better analgesia and fewer side effects compared to controlled-release oxycodone.

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Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass

Abstract: The study shows that a very fast track extubation protocol may be safely implemented in patients submitted to coronary artery bypass graft surgery with cardiopulmonary bypass.

Cited by 65 publications

References 21 publications

Fast-Track Cardiac Anaesthesia at a Tertiary Care Cardiac Centre in Nepal

Fast-Track Cardiac Anaesthesia at a Tertiary Care Cardiac Centre in Nepal

The management of fast-track cardiac anesthesia in a patient with right atrial myxoma

Early oral analgesia after fast-track cardiac anesthesia

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