Routine immediate extubation after cardiac operation: A review of our first 100 patients

Background. Early extubation after cardiac operation is an important aspect of fast-track cardiac anesthesia. Immediate extubation is an extension of this concept. We describe a technique that allows immediate extubation in t he majority of patients. Methods. To allow rapid emergence, anesthesia was modified from a high-dose opioid technique to intravenous propofol anesthesia supplemented with sevo flurane. Normothermic cardiopulmonary bypass was used with routine intermit tent antegrade and retrograde tepid blood cardioplegia. High thoracic epidu ral analgesia was used to facilitate immediate extubation in the majority o f patients. Contraindications to immediate extubation were prolonged cardio pulmonary bypass (CPB) (>2.5 hours), hemodynamic instability, uncontrolled bleeding, morbid obesity, severe pulmonary hypertension, congestive cardiac failure, or if the operation was emergent. Results. Of 109 consecutive patients, 100 were immediately extubated (92%). No patient required reintubation within the first 24 hours after operation . One patient required reintubation 3 days after operation for sputum reten tion, and 2 patients required reoperation. There was no mortality and the i ncidence of perioperative morbidity was low. Conclusions. Immediate extubation after cardiac operation can be safely ach ieved and is possible in a majority of patients. (C) 1999 by The Society of Thoracic Surgeons.