Impact of high spinal anesthesia technique on fast-track strategy in cardiac surgery: retrospective study

Abstract

Background and objectivesAlthough high spinal anesthesia (HSA) has been used in cardiac surgery, the technique has not yet been widely accepted. This retrospective study was designed to investigate the impact of HSA technique on fast-track strategy in cardiac surgery.MethodsElective cardiac surgery cases (n=1025) were divided into two groups: cases with HSA combined with general anesthesia (GA) (HSA group, n=188) and cases with GA only (GA group, n=837). In the HSA group, bupivacaine and morphine were intrathecally administered immediately before GA was induced. Outcomes included fast-track extubation (less than 6 hours), extubation in the operating room, fast-track discharge from the intensive care unit (ICU) (less than 48 hours) and hospital (less than 7 days).ResultsIn the HSA group, 60.1% were extubated in less than 6 hours after ICU admission, as compared with 39.9% in the GA group (p<0.001). In the HSA group, 33.0% were extubated in the operating room, as compared with 4.4% in the GA group (p<0.001). LOS in the ICU was less than 48 hours in 67.6% in the HSA group, as compared with 57.2% of those in the GA group (p=0.033). LOS in the hospital was less than 7 days in 63.3% in the HSA group, as compared with 53.5% in the GA group (p=0.084).ConclusionsHSA technique combined with GA in cardiac surgery increased the rate of fast-track extubation (less than 6 hours) when compared with GA only.

Protective effects of dexmedetomidine on the ischemic myocardium in patients undergoing rheumatic heart valve replacement surgery

“…Kehlet ( 25 ) pointed out that the application of Dex during the perioperative period may have important implications for Enhanced Recovery After Surgery (ERAS). Of note, using minimally invasive techniques and fast-track cardiac anesthesia for congenital heart disease surgery was reported to promote early extubation and accelerate patient recovery, which promoted ERAS ( 26 , 27 ).…”

Postoperative hemodynamics after high spinal block with or without intrathecal morphine in cardiac surgical patients: a randomized-controlled trial

“…31 Whether this improvement in pain scores results in improved outcomes after cardiac surgery is not known. 8,10,12,13,32 Another major concern with the use of intrathecal morphine is respiratory depression. In our study, intrathecal morphine did not increase the time to extubation, which was comparable in both groups, and no patient required reintubation.…”

“…[8][9][10][11] In this era of enhanced recovery after surgery, regional anesthesia is being increasingly used in cardiac surgery for pain control and to decrease the stress response. [10][11][12][13] Although there is a theoretical risk of spinal hematoma in patients who will get heparinized during surgery, the evidence does not support this increased risk when the block is placed at least one hour before anticoagulation. 10,14,15 Intrathecal morphine could be an attractive way of providing prolonged analgesia in patients undergoing cardiac surgery and is associated with less postoperative opioid use, decreased time to extubation, and a decrease in PPCs.…”

“…13 Although neuraxial anesthesia with intrathecal morphine has been studied in cardiac surgery, there is a dearth of literature regarding the hemodynamic effects of intrathecal morphine in combination with local anesthetics in cardiac surgery patients. [9][10][11][12][13]16,17 Vasoplegia after cardiac surgery is characterized by significant hypotension, high or normal cardiac index, low systemic vascular resistance, and increased requirements for fluids and vasopressors during or after CPB. With an incidence of 5-25%, it is difficult to treat and is associated with increased morbidity and mortality.…”

“…Invasive pressure monitoring of cardiac surgical patients and the timely use of bolus or continuous infusion of vasoactive agents like phenylephrine, norepinephrine, or epinephrine as per the hemodynamic requirements of underlying cardiac lesions enable successful use of such a technique. [8][9][10][11][12]16 The primary objective of this study was to compare the incidence of vasoplegia in two groups of patients, with one group receiving intrathecal local anesthetic and the other group receiving intrathecal morphine added to the local anesthetic. Secondary objectives included the time to extubation, postoperative rescue analgesic requirement, spirometry performance, and occurrence of any adverse event associated with intrathecal morphine (e.g., pruritus, nausea/vomiting, respiratory depression, and neuro-deficit) in the two groups.…”