Early Tracheal Extubation after Coronary Artery Bypass Graft Surgery Reduces Costs and Improves Resource Use

Abstract

Early tracheal extubation anesthetic management reduces total costs per CABG surgery by 25%, predominantly in nursing and in CVICU costs. Early extubation reduces CVICU and hospital length of stay but does not increase the rate or costs of complications when compared with patients in the late extubation group. It shifts the high CVICU costs to the lower ward costs. Early extubation also improves resource use after cardiac surgery when compared with late extubation.

Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

“…[1][2] The use of volatile anesthetics or iv propofol in combination with low-dose or short-acting opioids (fentanyl, alfentanil, remifentanil) [3][4] results in early extubation but requires supplemental analgesia in the early postoperative period with frequent patient discomfort or respiratory depression. The use of perioperative epidural anesthesia and analgesia allows intense postoperative analgesia, stress-response attenuation and thoracic cardiac sympathectomy with possible reduction of the risk of myocardial ischemia.…”

“…A two-hour sedation score using the Ramsay scale 11 and a four-hour analgesic score [visual analogue scale (VAS), [1][2][3][4][5][6][7][8][9][10] was recorded by the nurses in the ICU. Patients were questioned regarding the occurrence of pruritus, nausea and vomiting as well as intraoperative awareness.…”

“…3 Choice and advantages of the method used Recent evidence suggests that fast-track cardiac surgery is not only safe but may improve patient outcome by decreasing the incidence of postoperative cardiopulmonary morbidity and may lower the cost of cardiac surgery. [1][2][3]9 The optimal anesthetic technique to reach this goal remains debatable. TCI-propofol offers stable hemodynamics with minimal negative inotropism and a rapid and controlled recovery; it is widely used for noncardiac as well as cardiac surgery.…”

Impact of the opening of a specialized cardiac surgery recovery unit on postoperative outcomes in an academic health sciences centre

“…4 Nonetheless, the continued ability of cardiac surgery units to streamline postoperative care is under constraint in view of the increasing age and comorbidities of patients referred for surgery. Recent research has also demonstrated that the organizational features of intensive care units (ICUs) have a major impact on postoperative outcomes.…”

Regional analgesia and ultra-fast-track cardiac anesthesia

“…2,3 Many cardiac surgical centres have embraced the philosophy of FTCA over the past decade. Given the known cost benefits of FTCA techniques, there would appear to be no compelling reason to persist with highdose opioid regimens in routine cardiac surgical practice.…”