Early extubation after cardiac surgery: Emotional status in the early postoperative period

Objective: To compare the emotional state during the first 3 days after cor onary artery surgery of patients who had undergone early versus conventiona l extubation. Design: A prospective, randomized, controlled trial. Setting: University hospital, single center. Participants: Eligible patients (n = 100) presenting for elective coronary artery surgery, randomized to an early extubation group or a conventional e xtubation group. Interventions: Emotional status was measured by the Hospital Anxiety and De pression Scale (HAD), the Self Assessment Manikin (SAM), and the Multiple A ffect Adjective Check List-Revised (MAACL-R). Tests were administered preop eratively and on the 1st and 3rd days postoperatively. Measurements and Main Results: Of patients in the conventional extubation g roup, 30% showed moderate-to-severe depressive symptoms (HAD score > 10) on day 3 post-operatively compared with 8% of patients in the early extubatio n group (p = 0.02). There was a clinically insignificant increase in MAACL- R depression score on the 1st postoperative day within both groups but no o ther differences within or between groups in SAM or MAACL-R scores. Conclusion: Early extubation results in fewer patients displaying depressiv e symptoms on the 3rd postoperative day but appears to have little effect o n other measurements of emotional status. Anesthetic management during coro nary artery bypass graft surgery may play an important role in the overall well-being of the patient by decreasing the incidence of postoperative depr ession. Copyright (C) 2001 by W.B. Saunders Company.