The safety of immediate extubation after abdominal aortic surgery: A prospective, randomized trial

We performed this study to assess the safety of immediate extubation after elective abdominal aortic aneurysm surgery. Consecutive patients were prosp ectively randomized into two groups after surgery: Group 1 (n = 29) immedia te extubation; and Group 2 (n = 21) delayed (at least 4 h) extubation. All patients were assessed by a senior anesthesiologist or intensivist before e xtubation. The following data were collected: preoperative demographics, pr esence of comorbid disease, body mass index, hemoglobin level, heart rate, and blood pressure; intraoperative duration of surgery and cross-clamping, blood loss, amount of crystalloids, colloids, and blood transfused, tempera ture at end of procedure, urine output, and complications; and postoperativ e-time to extubation, scores on the Acute Physiology and Chronic Health Eva luation-II and Therapeutic Intervention Scoring System, total fentanyl dose , and complications. Outcome variables were length of intensive care unit a nd hospital stay and 28-day mortality. The results showed no significant di fferences in preoperative or intraoperative variables between the groups, a part from a longer duration of surgery in Group 1 (P = 0.045). Group 2 pati ents had a significantly higher Therapeutic Intervention Scoring System sco re (P = 0.04) and required a significantly larger dose of fentanyl (P < 0.0 01). One patient in Group 2 required reintubation after a cerebrovascular a ccident. The overall mortality rate was 4% (2 patients in Group 2). There w ere no significant differences in any of the outcome variables. We conclude that immediate extubation can safely be performed after elective abdominal aortic aneurysm surgery.