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Original ArticleOpen Access
Off-Pump Coronary Artery Bypass Surgery : Evaluation of Extubation Time and Predictors of Failed Early Extubation
Cumpeeravut P 
,
Visudharom K ,
lotisakulratana V ,
Pitiguagool V ,
Banyatpiyaphod S ,
Pamornsing P
,
Visudharom K ,
lotisakulratana V ,
Pitiguagool V ,
Banyatpiyaphod S ,
Pamornsing P KITIPAN VISUDHAROM, MD*,
VITOON PITIGUAGOOL, MD*,
PIYAPAN PAMORNSING, MD*
Anesthesia during and after off-pump surgery is critical for the outcome of the procedure.
Intubation time has been shown to correlate with ICU time and length of stay. This study is to evaluate
the extubation time and predictors of prolonged extubation in this institution.
One hundred and sixty consecutive patients during Jan 2001 -June 2002, excluding pre-
operative tracheostomy (n = 1) were retrospectively reviewed. Anesthetic agents include fentanyl,
rocuronium Bromide, midazolam and sevoflurane. Phenylephrine and nitroglycerine were used to main-
tain adequate arterial pressures. Post-operative pain control was mainly with intravenous fentanyl and
oral pain medications.
The extubation time was divided into 4 groups; 0-2 h, n = 76, mean =1.11
เธ‘
0.5 h; 2-4 h,
n = 30, mean= 2.91
เธ‘
0.5 h; 4-24 h, n = 39, mean= 11.44
เธ‘
7.3 h;
>
24 h, n = 5, mean= 33.3
เธ‘
21 h.
The data were collected and analyzed following the guidelines of National STS cardiac sur-
gery database. All pre-operative risk factors included: Age (> 70 yrs
vs
~
70 yrs), gender (male
vs
female), diabetes (yes
vs
no), hypertension (yes
vs
no), morbid obesity (yes
vs
no), renal insufficiency
(yes
vs
no), chronic obstructive lung disease (yes
vs
no), history of cerebrovascular accident (yes
vs
no), smoking (yes
vs
no), dyslipidemia (yes
vs
no), history of myocardial infarction (MI) (yes
vs
no),
history of congestive heart failure (CHF) (yes
vs
no), unstable angina (yes
vs
no), left ventricular
ejection fraction (L VEF) (> 40%
vs
~
40% ), left main (LM) lesion (LM > 50%
vs
LM
~
50%), intra-
aortic balloon pump (IABP) used (yes
vs
no) and time between operating and closing (> 4.30 h
vs
~
4.30 h) were used to predict failed early extubation (2 h)
More than 50 per cent of the patients were extubated in less than 2 h. ( 1.11
เธ‘
0.5 h) and only
5 patients were extubated after 24 h. Univariate analysis revealed old age, diabetes, MI, CHF, LVEF
~
0.4 and the use of IABP are the predictors (p
<
0.05) of failed early extubation. Multivariate analy-
sis of these variables revealed old age with adjusted odds ratio of 4.6 (95% CI = 1.5-13.7) p
<
0.01,
Vol. 86 Suppl I
OFF-PUMP CORONARY ARTERY BYPASS SURGERY
S29
diabetes with adjusted odds ratio of 3.2 (95% CI
=
1.3-7.5) p < 0.01 and IABP used with adjusted odds
ratio of 4.3 (95% Cl
=
1.3-14.6) p
=
0.02 are the predictors of fail early extubation. The findings sug-
gested early extubation is possible in OPCAB surgery and attention should be made when operate in
patients who have old age, diabetes, and IABP used.
Key word : Early Extubation in OPCAB
VITOON PITIGUAGOOL, MD*,
PIYAPAN PAMORNSING, MD*
Anesthesia during and after off-pump surgery is critical for the outcome of the procedure.
Intubation time has been shown to correlate with ICU time and length of stay. This study is to evaluate
the extubation time and predictors of prolonged extubation in this institution.
One hundred and sixty consecutive patients during Jan 2001 -June 2002, excluding pre-
operative tracheostomy (n = 1) were retrospectively reviewed. Anesthetic agents include fentanyl,
rocuronium Bromide, midazolam and sevoflurane. Phenylephrine and nitroglycerine were used to main-
tain adequate arterial pressures. Post-operative pain control was mainly with intravenous fentanyl and
oral pain medications.
The extubation time was divided into 4 groups; 0-2 h, n = 76, mean =1.11
เธ‘
0.5 h; 2-4 h,
n = 30, mean= 2.91
เธ‘
0.5 h; 4-24 h, n = 39, mean= 11.44
เธ‘
7.3 h;
>
24 h, n = 5, mean= 33.3
เธ‘
21 h.
The data were collected and analyzed following the guidelines of National STS cardiac sur-
gery database. All pre-operative risk factors included: Age (> 70 yrs
vs
~
70 yrs), gender (male
vs
female), diabetes (yes
vs
no), hypertension (yes
vs
no), morbid obesity (yes
vs
no), renal insufficiency
(yes
vs
no), chronic obstructive lung disease (yes
vs
no), history of cerebrovascular accident (yes
vs
no), smoking (yes
vs
no), dyslipidemia (yes
vs
no), history of myocardial infarction (MI) (yes
vs
no),
history of congestive heart failure (CHF) (yes
vs
no), unstable angina (yes
vs
no), left ventricular
ejection fraction (L VEF) (> 40%
vs
~
40% ), left main (LM) lesion (LM > 50%
vs
LM
~
50%), intra-
aortic balloon pump (IABP) used (yes
vs
no) and time between operating and closing (> 4.30 h
vs
~
4.30 h) were used to predict failed early extubation (2 h)
More than 50 per cent of the patients were extubated in less than 2 h. ( 1.11
เธ‘
0.5 h) and only
5 patients were extubated after 24 h. Univariate analysis revealed old age, diabetes, MI, CHF, LVEF
~
0.4 and the use of IABP are the predictors (p
<
0.05) of failed early extubation. Multivariate analy-
sis of these variables revealed old age with adjusted odds ratio of 4.6 (95% CI = 1.5-13.7) p
<
0.01,
Vol. 86 Suppl I
OFF-PUMP CORONARY ARTERY BYPASS SURGERY
S29
diabetes with adjusted odds ratio of 3.2 (95% CI
=
1.3-7.5) p < 0.01 and IABP used with adjusted odds
ratio of 4.3 (95% Cl
=
1.3-14.6) p
=
0.02 are the predictors of fail early extubation. The findings sug-
gested early extubation is possible in OPCAB surgery and attention should be made when operate in
patients who have old age, diabetes, and IABP used.
Key word : Early Extubation in OPCAB
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