Factors Associated with Safe Extubation in the Operating Room After On-Pump Cardiac Valve Surgery

Abstract

In select patients, extubation in the OR after on-pump valve surgery is safe. It is facilitated by shorter duration of CPB and pulmonary perfusion and ventilation during CPB. doi: 10.1111/jocs.12736 (J Card Surg 2016;31:274-281).

Minimally invasive cardiac surgery: A systematic review and meta-analysis

“…There was also a strong trend towards a reduced ventilation time in the MI group. This may lead to a decreased risk of ventilator associated pneumonia and airway trauma, and facilitate earlier mobilization and transfer to less stressful stepdown monitored units [20].…”

Predictors of operating room extubation in adult cardiac surgery

“…Previous studies have attempted to identify clinical factors that are associated with safe extubation in the OR in both selected and unselected cardiac surgical populations. [24][25][26][27][28][29][30][31] Anesthesia drugs and techniques used vary among those clinical trials, but they all have a common objective of extubation at the end of surgery. Regional analgesia (thoracic epidural 19 and paravertebral blocks 30 ), total intravenous anesthesia 32 (remifentanil, propofol), and short-acting inhalation anesthetics (sevoflurane and desflurane) 31 have been used to facilitate recovery and extubation on the operating table.…”

“…Longacting muscle relaxants, high dose of opioids (defined as fentanyl >20 mg/kg), and benzodiazepines such as midazolam are commonly avoided, especially in elderly patients. 23,24,26,27,31 Intrathecal morphine was used in patients undergoing thoracotomy in our study. We did not use other neuraxial blocks or total intravenous anesthesia.…”

“…The majority of prior studies focused on a selected cardiac surgical population, involved a smaller sample size, and included a limited set of perioperative variables. [26][27][28][29][30][31][32] The current study included all elective and urgent cardiac surgical procedures (on-and off-pump CABG, redo operations, isolated and multiple valve surgery and combined valve/CABG procedures, and sternotomy and thoracotomy approaches) representative of contemporary practice, and a comprehensive list of all preoperative and intraoperative variables from the STS database for association with OR extubation was examined. In addition to all STS variables, intraoperative anesthesia management data were included in the analysis unlike in previous studies, because anesthetic drug choice and dosages can significantly influence emergence after cardiac surgery.…”

Reintubación postoperatoria en pacientes sometidos a reemplazo valvular aórtico: extubación estándar vs ultra fast-track

“…Y aunque en nuestro estudio no encontramos diferencias estadísticamente significativas en cuanto a las características preoperatorias y transoperatorias, consideramos deben ser evaluados y reevaluados en futuros ensayos clínicos aleatorizados aquellos factores de riesgo adicionales referidos en la literatura internacional como la edad avanzada, la cirugía de urgencia, obesidad, antecedente de enfermedad pulmonar, hipertensión descontrolada preoperatoria, afección concomitante en el territorio de la arteria coronaria derecha (sobre todo el de la descendente posterior), antecedente de insuficiencia cardíaca y/o disfunción ventricular, inestabilidad hemodinámica sostenida transoperatoria, requerimiento de marcapasos (por bloqueo auriculoventricular [A-V]), sangrado, hipovolemia, pinzamiento aórtico mayor a 90 minutos, dificultades a la salida de bomba, tasa de opioide y temperatura transderivación cardiopulmonar (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) .…”