Off-Pump Coronary Artery Bypass Surgery : Evaluation of Extubation Time and Predictors of Failed Early Extuba tion
PRANOM CUMPEERAVUT, MD*, KITIPAN VISUDHAROM, MD*, VIBUL JOTISAKULRAT ANA, MD*, VITOON PITIGUAGOOL, MD*, SUJIT BANY ATPIY APHOD, MD*, PIYAPAN PAMORNSING, MD*
Affiliation : * Bangkok Heart Institute, Bangkok Hospital, Bangkok 10320, Thailand.
One hundred and sixty consecutive patients during Jan 2001 - June 2002, excluding pre operative tracheostomy (n = 1) were retrospectively reviewed. Anesthetic agents include fentanyl, rocuronium Bromide, midazolam and sevoflurane. Phenylephrine and nitroglycerine were used to main tain adequate arterial pressures. Post-operative pain control was mainly with intravenous fentanyl and oral pain medications.
The extubation time was divided into 4 groups; 0-2 h, n = 76, mean =1.11 ± 0.5 h; 2-4 h, n = 30, mean= 2.91 ± 0.5 h; 4-24 h, n = 39, mean= 11.44 ± 7.3 h; > 24 h, n = 5, mean= 33.3 ± 21 h. The data were collected and analyzed following the guidelines of National STS cardiac sur gery database. All pre-operative risk factors included: Age (> 70 yrs vs ~ 70 yrs), gender (male vs female), diabetes (yes vs no), hypertension (yes vs no), morbid obesity (yes vs no), renal insufficiency (yes vs no), chronic obstructive lung disease (yes vs no), history of cerebrovascular accident (yes vs no), smoking (yes vs no), dyslipidemia (yes vs no), history of myocardial infarction (MI) (yes vs no), history of congestive heart failure (CHF) (yes vs no), unstable angina (yes vs no), left ventricular ejection fraction (L VEF) (> 40% vs ~ 40% ), left main (LM) lesion (LM > 50% vs LM ~ 50%), intra aortic balloon pump (IABP) used (yes vs no) and time between operating and closing (> 4.30 h vs ~ 4.30 h) were used to predict failed early extubation (2 h) More than 50 per cent of the patients were extubated in less than 2 h. ( 1.11 ± 0.5 h) and only 5 patients were extubated after 24 h. Univariate analysis revealed old age, diabetes, MI, CHF, LVEF ~ 0.4 and the use of IABP are the predictors (p < 0.05) of failed early extubation. Multivariate analy sis of these variables revealed old age with adjusted odds ratio of 4.6 (95% CI = 1.5-13.7) p < 0.01, diabetes with adjusted odds ratio of 3.2 (95% CI = 1.3-7.5) p < 0.01 and IABP used with adjusted odds = = ratio of 4.3 (95% Cl 1.3-14.6) p 0.02 are the predictors of fail early extubation. The findings sug gested early extubation is possible in OPCAB surgery and attention should be made when operate in patients who have old age, diabetes, and IABP used.
Keywords : Early Extubation in OPCAB
