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Hemodynamic responses to endotracheal extubation after coronary artery bypass grafting
R Paulissian1, M R Salem, N J Joseph
1Department of Anesthesiology, Illinois Masonic Medical Center, Chicago 60657.
Insights
Tracheal extubation after coronary artery bypass grafting surgery caused minimal hemodynamic changes, and intravenous lidocaine did not alter these responses. These findings suggest extubation is safer than intubation post-CABG.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Patients undergoing coronary artery bypass grafting (CABG) face risks of myocardial ischemia, infarction, and arrhythmias post-surgery.
- Hemodynamic stability is crucial during the immediate postoperative period, especially during endotracheal extubation.
- The impact of extubation on hemodynamics and the potential benefit of lidocaine require further investigation in CABG patients.
Purpose of the Study:
- To evaluate the hemodynamic responses to endotracheal extubation in patients after CABG surgery.
- To determine the efficacy of intravenous lidocaine pretreatment in mitigating these hemodynamic responses.
- To compare the hemodynamic impact of extubation versus intubation in the CABG population.
Main Methods:
- A prospective study involving 25 patients undergoing CABG and overnight mechanical ventilation.
- Patients were randomized into two groups: placebo (n=13) and intravenous lidocaine (1 mg/kg).
- Hemodynamic parameters, ECG, and blood gases were monitored before, during, and after endotracheal extubation.
Main Results:
- Tracheal extubation led to transient, minor increases in heart rate, blood pressure, and cardiac index, which resolved within 5 minutes.
- No significant changes were observed in pulmonary or systemic vascular resistance.
- Lidocaine pretreatment did not significantly alter the hemodynamic responses to extubation.
- No electrocardiographic or enzymatic evidence of myocardial ischemia/infarction or ventricular dysrhythmias was detected.
Conclusions:
- Endotracheal extubation after CABG surgery is associated with modest and brief hemodynamic responses.
- These responses are less pronounced than those typically seen with tracheal intubation.
- Intravenous lidocaine does not appear to modify the hemodynamic effects of extubation in this patient group.
Abstract:
After coronary artery bypass grafting (CABG) surgery, patients may remain at risk for myocardial ischemia and infarction and ventricular dysrhythmias. The hemodynamic responses to endotracheal extubation and the efficacy of intravenous lidocaine pretreatment were studied after CABG surgery and overnight mechanical ventilation. Twenty-five patients were divided into two groups: group 1 (n = 13) patients who had tracheal extubation after pretreatment with a placebo; group 2 patients who received lidocaine (1 mg/kg IV) before tracheal extubation. Hemodynamic data, electrocardiographic tracings, and arterial blood gases were obtained before tracheal extubation, during suctioning, and 1, 5, and 20 min after tracheal extubation. Group 1 patients displayed significant increases in heart rate, arterial blood pressure, rate-pressure product, right atrial pressure, and cardiac index during suctioning and within 1 min of tracheal extubation, returning to preextubation level by 5 min. There were no significant changes in pulmonary and systemic resistance indices. Hemodynamic changes in group 2 patients were similar to those in group 1. Both in the absence and presence of lidocaine, tracheal extubation caused hemodynamic responses that were small in magnitude and brief in duration. These responses were not associated with electrocardiographic or enzymatic evidence of myocardial ischemia or infarction, or with ventricular dysrhythmias. Compared with the well-documented hemodynamic responses to tracheal intubation, we found that extubation of the trachea after CABG surgery was associated with less pronounced responses. This may be related to avoidance of laryngoscopy and possibly accommodation to the endo-tracheal tube. These modest hemodynamic responses of extubation of the trachea after CABG surgery were not modified by intravenous lidocaine.