To ventilate or not after minimally invasive direct coronary artery bypass surgery: the role of epidural anesthesia

Abstract

Objective: To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia.

Design: Randomized prospective study.

Setting: University hospital, single institution.

Participants: Patients (n = 90) scheduled for elective MIDCAB surgery.

Interventions: Patients were divided into 3 groups: 30 patients had general anesthesia and were extubated immediately after surgery (extubated group), 30 patients had a thoracic epidural and general anesthesia and were extubated immediately after surgery (epidural group), and 30 patients had general anesthesia and were ventilated after surgery (intubated group).

Measurements and main results: With a similar cardiac index and less vasoactive medication, mean arterial blood pressure (77 plus minus 8 mmHg [mean plus minus SD]) and heart rate (76 plus minus 10 beats/min) in the epidural group were lower on the first postoperative day than in the intubated group (83 plus minus 10 mmHg and 81 plus minus 13 beats/min) and the extubated group (86 plus minus 10 mmHg and 83 plus minus 13) (p = 0.01 and p = 0.09). Oxygenation on the first postoperative day was better in the epidural group than in the intubated group (14.8 plus minus 3.8 kPa v 12.6 plus minus 3.2 kPa; p = 0.05). The epidural group and the extubated group had a transient respiratory acidosis postoperatively. Pain score in the epidural group was lower on the first postoperative day than in the extubated group with general anesthesia (3.0 plus minus 1.6 visual analog scale v 4.6 plus minus 1.8 visual analog scale; p = 0.01). Hospital stay was shorter in the epidural group than in the ventilated group (5.9 plus minus 2.4 days v 8.1 plus minus 5.3 days; p = 0.05)

Conclusion: Immediate postoperative extubation in patients with thoracic epidural anesthesia and supplemental general anesthesia provides the most favorable clinical circumstances after MIDCAB surgery.