Hemodynamic Responses to Endotracheal Extubation After Coronary Artery Bypass Grafting

Abstract

After coronary artery bypass grafting (CABG) surgery, patients may remain at risk for myocardial ischemia and infarction and ventricular dysrhythmias. The hemodynamic responses to endotracheal extubation and the efficacy of intravenous lidocaine pretreatment were studied after CABG surgery and overnight mechanical ventilation. Twenty-five patients were divided into two groups: group 1 (n = 13) patients who had tracheal extubation after pretreatment with a placebo; group 2 patients who received lidocaine (1 mg/kg IV) before tracheal extubation. Hemodynamic data, electrocardiographic tracings, and arterial blood gases were obtained before tracheal extubation, during suctioning, and 1, 5, and 20 min after tracheal extubation. Group 1 patients displayed significant increases in heart rate, arterial blood pressure, rate-pressure product, right atrial pressure, and cardiac index during suctioning and within 1 min of tracheal extubation, returning to preextubation level by 5 min. There were no significant changes in pulmonary and systemic resistance indices. Hemodynamic changes in group 2 patients were similar to those in group 1. Both in the absence and presence of lidocaine, tracheal extubation caused hemodynamic responses that were small in magnitude and brief in duration. These responses were not associated with electrocardiographic or enzymatic evidence of myocardial ischemia or infarction, or with ventricular dysrhythmias. Compared with the well-documented hemodynamic responses to tracheal intubation, we found that extubation of the trachea after CABG surgery was associated with less pronounced responses. This may be related to avoidance of laryngoscopy and possibly accommodation to the endo-tracheal tube. These modest hemodynamic responses of extubation of the trachea after CABG surgery were not modified by intravenous lidocaine.

Cardiopulmonary Predicators of Dysfunctional Ventilator Weaning Response after Coronary Artery Bypass Graft

“…This finding implies that the patients who had lower CI developed DVWR. This finding is consistent with past literature that reported an alteration in cardiac index during weaning was found to have association with weaning failure (15,(76)(77)(78). However, the logistic prediction model revealed that CI is not a significant antecedence to predict the DVWR after CABG surgery.…”

Attenuation of hemodynamic responses to endotracheal extubation: A prospective randomised controlled study between two different doses of Verapamil

“…Though tracheal extubation seems to be a benign procedure, multiple studies have shown that it can cause significant increase in BP and HR which may persist till the recovery period. [1][2][3][4][5][6] High degree of sympathetic stimulation, as evidenced by tachycardia, hypertension and increased levels of circulating catecholamines during extubation may prove to be detrimental to their health or to the successful outcome of surgery.Hypertensive subjects exhibit an exaggerated response to laryngoscopy and intubation as well as to awakening and extubation compared to normotensive patients. 7,13,45 Increase in BP, HR and RPP which is a multiple of SBP and HR increases the cardiac workload and the oxygen demand of the myocardium; increasing the risk of developing a fresh episode of myocardial ischemia and infarction in known patients of ischemic heart disease due to a fixed coronary blood flow, along with fall in cardiac index and ejection fraction.…”

“…Postoperative extubation of trachea is an important event in the course of general anaesthesia which causes a modest (10% to 30%) and transient (lasting approximately 5 to 15 minutes) increase in the HR and BP. [1][2][3][4][5][6][7] Normally these responses are transient in nature hence well tolerated by normotensive healthy subjects.…”

Extubation and Reintubation of the Difficult Airway

“…60 After coronary artery bypass surgery, these changes tend to be transient, lasting 5 to 10 minutes, and they usually are not associated with electrocardiographic evidence of myocardial ischemia. 61 Coronary sinus lactate extraction measurements, however, indicate that among patients with poor cardiac function, extubation may be associated with myocardial ischemia. 62 Patients with inadequately controlled hypertension, carcinoid, pheochromocytoma, hypertension associated with pregnancy, or hyperthyroidism may be expected to display even greater increases in blood pressure in response to tracheal extubation.…”