Early extubation after abdominal aortic reconstruction

Stoneham, Mark D.; Neill, Fiona

doi:10.1016/s1053-0770(99)90198-2

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…7–9,15 Various centers have published protocols for perioperative management after OAR with the goal of shortening LOS while maintaining patient safety. 16,17 Ours is the first large study focusing specifically on timing of extubation for this patient population.…”

Section: Discussionmentioning

confidence: 99%

Early extubation is associated with reduced length of stay and improved outcomes after elective aortic surgery in the Vascular Quality Initiative

David

Brooke

Hanson

et al. 2017

Journal of Vascular Surgery

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Objective Timing of extubation after open aortic procedures varies across hospitals. This study was designed to examine extubation timing and determine its effect on length of stay (LOS) and respiratory complications after elective open aortic surgery. Methods We studied extubation timing for 7171 patients undergoing elective open abdominal aortic aneurysm repair (2687 [37.5%]) or suprainguinal bypass for aortoiliac occlusive disease (4484 [62.5%]) from October 2010 to April 2015 in hospitals participating in the Vascular Quality Initiative (VQI). Our primary outcome was prolonged LOS (>7 days), and the secondary outcome was respiratory complications (pneumonia or reintubation). The association between extubation timing and outcomes was assessed using multivariable logistic regression mixed-effects models that adjusted for confounding factors at the patient and procedure level. A variable importance analysis was conducted using a chi-pie framework to identify factors contributing to the variability of extubation timing. Results The 7171 patients undergoing abdominal aortic surgery were a mean age of 65.4 (standard deviation, 10.2) years, and 63% were male. Extubation occurred (1) in the operating room (76.3%), (2) <12 hours (10.9%), (3) 12 to 24 hours (7.2%), or (4) >24 hours (5.6%) after surgery. Hospitals in the top quartile for case volume had the highest percentage of patients extubated in the operating room (82.8%). Patients least likely to be extubated in the operating room were older, more likely to have chronic obstructive pulmonary disease, require vasopressors, have higher estimated blood loss (EBL), and longer procedure times. After adjustment for patient, procedure, and institutional factors, delayed extubation was associated with prolonged LOS (<12 hours: odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2–1.7; 12–24 hours: OR, 2.1; 95% CI, 1.7–2.7; >24 hours: OR, 5.3; 95% CI, 4.0–6.9), and pulmonary complications (<12 hours: OR, 1.9; 95% CI, 1.4–2.6; 12–24 hours: OR, 2.6; 95% CI, 1.8–3.6; >24 hours: OR, 9.6; 95% CI, 7.1–13.0) compared with those extubated in the operating room. Subset analysis of patients extubated in the operating room or <12 hours showed that extubation out of the operating room was associated with prolonged LOS (OR, 1.4; 95% CI, 1.2–1.7) and pulmonary complications (OR, 1.8; 95% CI, 1.3–2.5). The variable importance analysis demonstrated that EBL (26%) and procedure time (24%) accounted for half of the variation in extubation timing. Conclusions Extubation in the operating roomis associated with shorter LOS and morbidity after open aortic surgery. EBL, procedure time, and center variation account for variability in extubation timing. These data advocate for standardized perioperative respiratory care to reduce variation, improve outcomes, and reduce LOS.

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Section: Discussionmentioning

confidence: 99%

Early extubation is associated with reduced length of stay and improved outcomes after elective aortic surgery in the Vascular Quality Initiative

David

Brooke

Hanson

et al. 2017

Journal of Vascular Surgery

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“…The maintenance of body temperature during major abdominal surgery is important as it may reduce blood loss and transfusion requirements, reduce time in recovery and be associated with lower overall anaesthetic costs [9]. In addition, since temperature is one of the criteria by which a patient is judged ready to extubate after surgery, patients undergoing aortic surgery who are normothermic at the end of surgery might be considered to be ready for extubation earlier than those who are hypothermic [10, 11].…”

Section: Discussionmentioning

confidence: 99%

Heat loss during induction of anaesthesia for elective aortic surgery

Stoneham

Howell²,

Neill

2000

Anaesthesia

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We have studied core temperature changes occurring during induction of general anaesthesia and surgery in 18 patients undergoing elective aortic aneurysm repair. In the operating theatre, all patients were warmed with a forced-air warmer and a warming mattress, and received warmed (37 degrees C) intravenous fluids. Despite this, mean (SD) [range] core temperatures in the anaesthetic room decreased by 1.5 (0.3)[1.1-2.2] degrees C, while intravascular lines, epidural and urinary catheters were inserted before the introduction of warming methods in theatre. In one-third of patients, the core temperature was still below 36 degrees C at the end of surgery. The overall temperature decrease correlated significantly with the duration of time between induction of general anaesthesia and surgical incision (R2 = 0.6912), when the patients were not being warmed. Hypothermia may thus be prevented by minimising the period that the patient is anaesthetised without being warmed. Vascular lines, urinary and epidural catheters should be inserted before the induction of general anaesthesia or, alternatively, warming methods should be introduced in the anaesthetic room.

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“…Both pulmonary artery catheterization and epidural anesthesia or analgesia are sometimes recommended for clinical cases such as aortic surgery, coronary artery bypass graft and thoracotomy. [10][11][12][13][14] For such cases, cSvO 2 can be a useful monitor. In the absence of a pulmonary artery catheter, the arterial lactate variation, end-tidal CO 2 and ECG changes may be useful variables for detecting the cardiac toxicity of bupivacaine.…”

Section: R Re Es Su Ul Lt Ts Smentioning

confidence: 99%

“…cSvO 2 is rarely used in most cases where bupivacaine toxicity is likely to occur, however, epidural anesthesia or analgesia is sometimes recommended for major operations that may require pulmonary artery catheterization. [10][11][12][13][14] We hypothesized that cSvO 2 monitoring would reflect CO changes induced by bupivacaine infusion better than mean arterial blood pressure (MBP). The purpose of this study was to investigate changes of cSvO 2 and MBP when CO decreases and, ultimately, to compare the correlation between CO and cSvO 2 or MBP in dogs with bupivacaine-induced cardiac depression.…”

mentioning

confidence: 99%