Immediate extubation after aortic valve surgery using high thoracic epidural analgesia or opioid-based analgesia

Hemmerling, Thomas M.; Lê, Nhiên; Olivier, J; Choinière, Jean-Luc; Basile, Fadi; Prieto, Ignatio

doi:10.1053/j.jvca.2005.01.027

Cited by 48 publications

(24 citation statements)

References 17 publications

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“…4 -12 In addition, ultra fast-track therapy with extubation in the operation room failed to reduce length of stay in ICU or in hospital even with the use of thoracic epidural analgesia. 11,12 We hypothesized that it may be possible to avoid ICU admission entirely in selected cardiac surgery patients by implementing a fast-track protocol with direct admission from the operating room to a postanesthestic care unit (PACU), without the use of epidural anesthesia. Implementation of a PACU staffed by anesthesiologists and anesthetic nurses may be more feasible than in the ICU, where staff are not necessarily trained in the methods of early extubation.…”

mentioning

confidence: 99%

Cardiac Surgery Fast-track Treatment in a Postanesthetic Care Unit

Ender¹,

Borger

Scholz³

et al. 2008

Anesthesiology

129

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mentioning

confidence: 99%

Cardiac Surgery Fast-track Treatment in a Postanesthetic Care Unit

Ender¹,

Borger

Scholz³

et al. 2008

Anesthesiology

129

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“…For these reasons epidural blockade is a crucial element fast-track surgery, especially in patients undergoing abdominal, gynaecological, urological, thoracic and vascular surgery. Furthermore, thoracic epidural analgesia has been introduced even in patients undergoing fast-track cardiac surgery, and it has been shown to speed the recovery from anesthesia, decrease cardiovascular and respiratory complications, and decrease the length of stay in intensive care unit [158,[267][268][269]. However, although the risk of neurological complications seems to be low, more studies need to assess its safety [269].…”

Section: Epidural Analgesiamentioning

confidence: 99%

Anesthetic and Adjunctive Drugs for Fast-Track Surgery

Baldini¹,

Carli²

2009

CDT

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With the changes in health care dictated by economic pressure, there has been a realization that hospital stay could be shortened without compromising quality of care. Advances in surgical technology and anesthetic drugs have made an impact in the way perioperative care is delivered with some emphasis on multidisciplinary approach. From the expansion of ambulatory care, lessons were learnt how to apply same concepts to major surgery with the understanding that interventions to attenuate the surgical stress would facilitate the return to "baseline". Beside minimal invasive approach to surgery, anesthesia interventions are arranged with the intent to decrease the negative effects of surgical stress and pain, to minimize the side effects of drugs and at the same time to facilitate the recuperation which follows after surgery. Fast-track or accelerated care encompasses many aspects of anesthesia care, not only preoperative preparation and prehabilitation, but intraoperative attenuation of surgical stress and postoperative rehabilitation. The anesthesiologist is part of this team with the specific mission to use medications and techniques which have the least side effects on organ functions, provide analgesia which in turn facilitates the intake of food and mobilization out of bed. This chapter has been conceived with the intention to direct the clinician towards procedure-specific protocols where the choice of medications and techniques is based on published evidence. The success of implementing fast-track depends more on dynamic harmony amongst the various participants (surgeons, anesthesiologists, nurses, nutrtionists, physiotherapists) than on reaching an optimum level of excellence at each separate organization level.

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“…In fi rst track anesthetic protocol which is the norm in modern day practice of cardiac surgery, early extubation along with a stable hemodynamics is the goal; that is greatly facilitated by effective postoperative analgesia [1]. Regional anesthesia for postoperative pain relief has additional benefi ts like attenuation of altered circulatory, metabolic, immunological and hemostatic systems [2,3].…”

Section: Introductionmentioning

confidence: 99%

Parasternal Block with Two Different Concentration of Ropivacaine for Post-Operative Analgesia in Patient Undergoing Coronary Artery Bypass Grafting: A Randomized Double Blind Controlled Trial

Choudhury¹

2017

Open J Pain Med

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Background: Postoperative sternal pain is one of the most important factors affecting patients' quality of life during the early post-operative days. Optimal pain management after cardiac surgery improve comfort and wellbeing of the patients. Conventionally used techniques of postoperative analgesia mostly provided by intravenous route, have their own side effects, causing a delay in tracheal extubation. Parasternal intercostals block is one such technique which has several potential advantages and devoid of the above side effects. Objective:To study the effect and effi cacy of parasternal intercostals block analgesia with two different doses of ropivacaine for post-operative analgesia in patients undergoing coronary artery bypass grafting (CABG).Design: Randomized, prospective, double blind study Setting: Tertiary health care teaching hospital Participants: One hundred and twenty adult cardiac surgical patients scheduled for elective coronary artery bypass grafting.Intervention: 0.75% ( group R1) and 0.5% (group R2) ropivacaine injection with 5 doses of 4 ml each on each side of Parasternal intercostals space with a total dose of ropivacaine 200 mg and 300 mg respectively or same volume of saline (group S) prior to surgical incision. Measurements and results:The average time of extubation was signifi cantly lower in R1 and R2 group compared to S group, being 5.15±1.13,5.24±0.88 and 7.29±1.41 hours respectively (p <0.0010).The length of ICU stay was 1.67±0.57 days in group R1,2.0±0.61 days in group R2 and 2.11±0.64 days in group S ( p=0.007) . A similar fi nding was also present when the duration of hospital stay was concerned. The cumulative 24 hr fentanyl dose was signifi cantly higher in group S compared to that of R1 and R2. (186.73±28.3, 217±36.8 and 344±68.2 μ gm respectively, p, 0.01).VAS score was highest in S group of patients with a mean of 5.08±0.82 for all the time periods, whereas that for group R1 and R2 was 3.64±0.84 and 3.77±0.71 respectively except that at post extubation. Statistical signifi cance was observed for VAS score during inter group comparison (R1 vs S, p<0.001, R2 vs. S,p<0.001). The mean heart rate and mean arterial pressure remained in higher side in group S patients when compared to the other two groups (p < 0.01 in each case). One patient in group R1, three in group R2 and seven in group S had arrhythmia during their ICU stay. Two patients from each R2 and S group had evidence of pneumonia and none of the patients in any group had evidence of sternal wound infection during the course of stay and one month follow up period. Conclusion:Parasternal intercostals block for postoperative pain relief for adult cardiac surgical patients is a simple technique, which is easy to perform and appears to be a useful adjunct to post-operative pain relief during the postoperative period. 0.75 % ropivacaine is more effi cacious than that of 0.5% when used in the same route without any additional side effects. Unlike neuroaxial blocks, it can be used in patients who are anti-coagulated per...

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Immediate extubation after aortic valve surgery using high thoracic epidural analgesia or opioid-based analgesia

Cited by 48 publications

References 17 publications

Cardiac Surgery Fast-track Treatment in a Postanesthetic Care Unit

Cardiac Surgery Fast-track Treatment in a Postanesthetic Care Unit

Anesthetic and Adjunctive Drugs for Fast-Track Surgery

Parasternal Block with Two Different Concentration of Ropivacaine for Post-Operative Analgesia in Patient Undergoing Coronary Artery Bypass Grafting: A Randomized Double Blind Controlled Trial

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