Operating room (OR) extubation after off pump coronary artery bypass grafting surgery: its feasibility and effect on post operative complication: a prospective study

Abstract

Background: The expansion of coronary surgery on the beating heart without cardiopulmonary bypass has led to increasing interest in ultra-fast track anesthesia, allowing extubation of the patient in the operating room. Ultrafast tracking of anesthesia (UFTA) is practiced routinely, whereas immediate on-table extubation after off-pump coronary artery bypass (OPCAB) grafting surgery has many concerns. The purpose of our study was to evaluate the safety and feasibility of Operating Room (OR) extubation.Methods: Authors have conducted a study in 158 patients undergone OPCAB. Patients were observed carefully for their intraoperative behavior in terms of hemodynamics, urine output, requirement of inotropes, bleeding and body temperature and then selected for OR extubation. Post-operative complications such as bleeding, reoperation, re-intubation and ventilation, stroke, deep sternal infection and in-hospital mortality were checked. Serial ABG (Arterial Blood Gas) (pO2, pCO2 and O2 saturation) was performed: preoperative, pre-extubation (OR), Intensive Thoracic Unit (ITU) on transfer and ITU 4 hours.Results: Authors found OR extubation was safely feasible in 151 patients. 4 patients were reintubated and there were 2 in hospital mortality. None had deep sternal infection. The analysis of arterial Blood Gas revealed no significant changes between pre and post-operative values. All hospital survivors were discharged between 6th and 8th postoperative days.Conclusions: Our results concluded that Operating Room (OR) extubation is feasible in the majority of patients undergoing OPCAB and the technique is safe, effective and does not increase post-operative complications.