Immediate extubation after aortic valve surgery using high thoracic epidural analgesia or opioid-based analgesia

Objective: Fast-track anesthesia has gained widespread use in cardiac centers around the world. No study has been published focusing on immediate extubation after aortic valve surgery. This study examines the feasibility and hemodynamic stability of immediate extubation after simple or combined aort...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2005-04, Vol.19 (2), p.176-181
Main Authors: Hemmerling, Thomas M., Lê, Nhiên, Olivier, Jean-François, Choinière, Jean-Luc, Basile, Fadi, Prieto, Ignatio
Format: Article
Language:English
Subjects:
Adult
Aged
Analgesia, Epidural
Analgesia, Patient-Controlled
Analgesics, Opioid - therapeutic use
Anesthesia, General
Aortic Valve - surgery
Blood Pressure - physiology
Cardiac Surgical Procedures
Cardiopulmonary Bypass
early extubation
Female
Hemodynamics
Humans
Intubation, Intratracheal
Male
Middle Aged
Monitoring, Intraoperative
opioid analgesia
Pain Measurement - drug effects
Pain, Postoperative - drug therapy
Pilot Projects
Postoperative Complications - diagnosis
Postoperative Complications - physiopathology
Prospective Studies
thoracic epidural analgesia
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Summary:Objective: Fast-track anesthesia has gained widespread use in cardiac centers around the world. No study has been published focusing on immediate extubation after aortic valve surgery. This study examines the feasibility and hemodynamic stability of immediate extubation after simple or combined aortic valve surgery using either thoracic epidural analgesia or opioid-based analgesia. Design: Prospective audit, pilot study. Setting: Single-institution university medical center. Participants: Adult patients undergoing aortic valve replacement (N = 45). Interventions: Forty-five patients undergoing aortic valve surgery with an ejection fraction of more than 30% were included in this prospective audit. Induction of anesthesia was done using fentanyl, 2 to 4 μg/kg, propofol, 1 to 2 mg/kg, and endotracheal intubation facilitated by rocuronium; anesthesia was maintained using sevoflurane titrated according to bispectral index (BIS [BIS target: 50]). Perioperative analgesia was provided by high thoracic epidural analgesia (TEA group, bupivacaine 0.125%, 6 to 14 mL/h) or fentanyl, up to 10 μg/kg, followed by patient-controlled analgesia with morphine (OPIOID group). Measurements and main results: Success of extubation within 30 minutes after surgery was recorded. Hemodynamic data during surgery were compared by using an analysis of variance test; p < 0.05 was considered as showing a significant difference. Data presented as median (25th-75th percentile). In the TEA group, patients underwent simple aortic valve replacement (N = 21) or combined aortic valve surgery (N = 14), with additional coronary artery bypass grafting (N = 10) and replacement of the ascending aorta (Bentall, N = 4). In the OPIOID group, patients underwent simple aortic valve replacement (N = 5) or combined aortic valve surgery (N = 5), with additional aortocoronary bypass grafting (N = 2), replacement of the ascending aorta (Bentall, N = 2), and reconstruction of the mitral valve (N = 1). All 45 patients were extubated within 15 minutes after surgery. There was no need for reintubation; pain scores were lower in the TEA group than in the OPIOID group immediately after surgery and at 6 hours, 24 hours, and 48 hours after surgery. For the TEA group and OPIOID group, the pain scores were 0 (0–2), 0 (0–2), 0 (0–1.5), and 0 (0–0) and 5 (4–5.75), 4 (3–4.5), 4 (3.25–4), and 1 (0–2.5), respectively. During and up to 6 hours after surgery, there was no significant hemodynamic difference between the TEA and
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2005.01.027