Early extubation and fast-track anesthetic technique for endoscopic cardiac surgery

In this retrospective study, we evaluated the "fast-track" recovery protocol for endoscopic Port Access (PA) (Edwards Lifesciences) heart procedures. We also determined which factors and variables are important for the success of immediate extubation at the end of the operation while the patient is still in the operating room (OR).

In the study, we included 104 patients scheduled for PA heart surgery under cardioplegic arrest. All patients were marked before surgery for the fast-track recovery protocol. If the patients fulfilled the extubation criteria within 10 to 15 minutes after the end of operation, they were extubated in the OR (OR group); the others were transferred to the intensive care unit (ICU) (ICU group) and extubated later. The 2 groups were compared with respect to preoperative and intraoperative variables that could influence early extubation, postoperative complications, duration of ICU stay, and hospital stay.

Seventy-eight patients (75%) were extubated in the OR. The patients from the OR group had significantly lower EuroSCOREs than the patients from the ICU group (P = .025). The variables of vital capacity (P = .001) and forced expiratory volume in the first second (FEV1) (P < .001) were significantly higher preoperatively in the OR group than in the ICU group. There were no significant differences between the groups with respect to intraoperative characteristics. Postoperative complications were fewer in the OR group. The mean duration of ICU stay was significantly shorter in the OR group than in the ICU group (P < .001).

Immediate extubation in the OR after endoscopic cardiac procedures is safe and possible for the majority of patients. The preoperative patient characteristics of Euro-SCORE, vital capacity, and FEV1 influence the success of ontable extubation.