Pro: Early Extubation (

Abstract

INDUCTION. MAINTENANCE. EMERGENCE. These 3 phases are the cornerstones of a good anesthetic. Unless, of course, you are referring to anesthesia for cardiac surgery. Traditional cardiac anesthesia involves induction and maintenance of anesthesia but leaves emergence to occur in the intensive care unit (ICU) at some later time. Little has changed in this philosophy over the years, and this practice is accepted commonly throughout the cardiac surgical field. In contrast to this commonly accepted treatment methodology, there is evidence suggesting early tracheal extubation, within 1 hour of surgery, may be beneficial for some patients. Early extubation may reduce pulmonary complications and reduce costs associated with the ICU without increasing mortality of patients undergoing cardiac surgery. 1 Reyes A Vega G Blancas R et al. Early vs. conventional extubation after cardiac surgery with cardiopulmonary bypass. Chest. 1997; 112: 193-201 Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar , 2 Cheng DC Karski J Peniston C et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: A prospective randomized controlled trial. J Thorac Cardiovasc Surg. 1996; 112: 755-764 Abstract Full Text Full Text PDF PubMed Scopus (300) Google Scholar , 3 Cheng DC Karski J Peniston C et al. Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use: A prospective, randomized, controlled trial. Anesthesiology. 1996; 85: 1300-1310 Crossref PubMed Scopus (335) Google Scholar , 4 Cheng DC Wall C Djaiani G et al. Randomized assessment of resource use in fast-track cardiac surgery 1-year after hospital discharge. Anesthesiology. 2003; 98: 651-657 Crossref PubMed Scopus (74) Google Scholar , 5 Guller U Anstrom KJ Holman WL et al. Outcomes of early extubation after bypass surgery in the elderly. Ann Thorac Surg. 2004; 77: 781-788 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar , 6 Svircevic V Nierich AP Moons KG et al. Fast-track anesthesia and cardiac surgery: A retrospective cohort study of 7989 patients. Anesth Analg. 2009; 108: 727-733 Crossref PubMed Scopus (66) Google Scholar , 7 Myles PS Daly DJ Djaiani G et al. A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. Anesthesiology. 2003; 99: 982-987 Crossref PubMed Scopus (43) Google Scholar , 8 Sato M Suenaga E Koga S et al. Early tracheal extubation after on-pump coronary artery bypass grafting. Ann Thorac Cardiovasc Surg. 2009; 15: 239-242 PubMed Google Scholar In this article, the authors counter the arguments put forth by Dr. Bhatia et al. and examine the evidence supporting early extubation after cardiac surgery.