MYOCARDIAL-ISCHEMIA AFTER CORONARY-ARTERY BYPASS-GRAFTING - EARLY VS LATE EXTUBATION

The technique of early extubation after coronary artery bypass graftin g is increasing in popularity, but its safety and effect on myocardial ischaemia remain to be established. In a randomized, prospective stud y, patients undergoing routine elective coronary artery bypass graftin g were managed with either early or late tracheal extubation. The inci dence and severity of electrocardiographic myocardial ischaemia were c ompared. Data were analysed from 85 patients (43 early extubation; 42 late extubation). Median time to extubation was 110 min in the early e xtubation patients and 757 min in the late extubation patients. After correction for randomization bias, there were no significant differenc es between groups in ischaemic burden, maximal ST-segment deviation, i ncidence of ischaemia and area under the ST deviation-time curve (inte gral of ST deviation and time). Similarly, there were no differences b etween groups in postoperative creatine kinase MB-isoenzyme concentrat ions and duration of stay in the ICU or hospital. Therefore, this stud y provides evidence for the safety of early extubation after routine c oronary artery bypass grafting.