Morbidity outcome in patients with hypertrophic obstructive cardiomyopathyundergoing cardiac septal myectomy: Early-extubation anesthesia versus high-dose opioid anesthesia technique

Objective: Anesthetic management of patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing septal myectomy is challenging. The morbid ity outcome of early-extubation anesthesia (EEA), or fast tracking, versus high-dose opioid (HDO) anesthesia was studied. Design: Retrospective study. Setting: University teaching hospital. Participants:One hundred seventy-five cardiac septal myectomy patients (EEA , n = 53; HDO, n = 122). Interventions: EEA technique consisted of low-dose fentanyl, 10 to 15 mu g/ kg; propofol infusion; midazolam; and inhalation agent. HDO technique consi sted of fentanyl, 50 to 100 mu g/kg, and benzodiazepines, with or without a n inhalation agent. Demographic data, preoperative symptoms, and data on an esthesia management and postoperative complications were recorded. Measurements and Main Results: There were no differences between the groups (EEA v HDO, respectively) regarding age, sex, preoperative symptoms (dyspn ea, 89% v 79%; palpitations, 28% v 26%; angina, 47% v 61%; syncope, 47% v 4 1%), redo surgery, or combined surgery. Mean +/- standard deviation time to tracheal extubation was 7.2 +/- 5.3 hours in EEA versus 19.4 +/- 10.5 hour s in HDO patients (p < 0.0001). Intensive care unit (ICU) stay was signific antly shorter in EEA versus HDO patients (2.2 v 3.0 days; p < 0.005), with the trend toward earlier hospital discharge (9.7 v 11.3 days; p = 0.09). Th ere was a high requirement for temporary pacing in both groups immediately postoperatively (EEA, 60% v HDO, 48%; p > 0.08). Permanent pace-maker inser tion postoperatively was required in 7 of 53 patients (13%) in the EEA grou p and 11 of 122 patients (9%) in the HDO group (p > 0.25). Atrial arrhythmi as occurred postoperatively in 25% of EEA patients versus 34% of HDO patien ts (p > 0.08). Conclusion: EEA facilitates earlier tracheal extubation by 12 hours in pati ents with HOCM undergoing septal myectomy, significantly shortening ICU sta y by 1 day without increasing perioperative cardiac morbidity or mortality. Copyright (C) 1999 by W.B. Saunders Company.