The Benefits of early Extubation in OR and ICU after Cardiac Surgery

Abstract

Objective: Operating room (OR) extubation after adult cardiac surgery with cardiopulmonary bypass CPB is rare. We examined the outcome, factors, and benefits of OR extubation.
 Methods: We operated on 60 patients in German Hospital Tirana, from January 2019 to September 2020, who had undergone CABG cardiac operations: 52 patients, mitral valve repair 5 patients, aortic stenosis 1patient, Bentall procedure 1 patient, left atrial myxoma 1 patient. The patient's age was from 46-82 years old, there were 24 female patients and 36 male patients, 24 diabetic patients, 36 non-diabetic patients, in all cases we did not apply epidural anesthesia.
 Anesthesia was used with low doses of fentanyl. in combination with propofol, sevoflurane. In all cases, neostigmine was used for decurarisation.
 The quality and depth of anesthesia were assessed with obvious signs such as tachycardia, hypertension, sweating. Endogenous stress was also assessed by monitoring glycemia during the intervention.
 As extubation criteria were assessed the patient's consciousness, respiratory mechanics, hemodynamic stability, diuresis, bleeding from drains.
 Results: 16 patients were extubated in the OR and 44 patients were extubated 15-20 minutes after the intervention in ICU. There was no reintubation. 2 patients were transferred immediately from OR to the pavilion. 35 patients were transferred to the pavilion 3-4 hours after extubation. 23 patients were transferred to the pavilion the next morning. Patients left the hospital after 5-7 days.
 Conclusions: Extubation in the OR in the early postoperative period has now become a routine in all specialized clinics. The time spent in the ICU is very low and the day spent in the ward was 5-7 days. The benefit is in the best and fastest activation of patients in the early postoperative period as well as in reduced intervention costs.