Related Experiment Video
Updated: Jan 3, 2026
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Impact of high spinal anesthesia technique on fast-track strategy in cardiac surgery: retrospective study
Satoshi Hanada1, Atsushi Kurosawa2, Benjamin Randall3
1Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Insights
High spinal anesthesia combined with general anesthesia significantly improved fast-track extubation rates in cardiac surgery patients. This approach enhances recovery, allowing quicker removal from mechanical ventilation compared to general anesthesia alone.
Area of Science:
- Anesthesiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- High spinal anesthesia (HSA) is an underutilized technique in cardiac surgery.
- Investigating HSA's impact on fast-track protocols is crucial for patient recovery.
Purpose of the Study:
- To evaluate the effectiveness of high spinal anesthesia combined with general anesthesia for fast-track cardiac surgery.
- To compare fast-track extubation and discharge times between HSA and general anesthesia (GA) groups.
Main Methods:
- Retrospective study of 1025 elective cardiac surgery patients.
- Two groups: HSA with GA (n=188) and GA only (n=837).
- HSA group received intrathecal bupivacaine and morphine before GA induction.
Main Results:
- Significantly higher fast-track extubation (<6 hours) in HSA group (60.1%) vs. GA group (39.9%).
- Extubation in the operating room occurred in 33.0% of HSA patients vs. 4.4% of GA patients.
- Shorter ICU length of stay (<48 hours) observed in HSA group (67.6%) compared to GA group (57.2%).
Conclusions:
- High spinal anesthesia combined with general anesthesia enhances fast-track extubation rates in cardiac surgery.
- HSA facilitates earlier extubation and potentially shorter intensive care unit stays.
- The HSA technique shows promise for improving patient recovery pathways in cardiac procedures.
Background And Objectives:
Although high spinal anesthesia (HSA) has been used in cardiac surgery, the technique has not yet been widely accepted. This retrospective study was designed to investigate the impact of HSA technique on fast-track strategy in cardiac surgery.
Methods:
Elective cardiac surgery cases (n=1025) were divided into two groups: cases with HSA combined with general anesthesia (GA) (HSA group, n=188) and cases with GA only (GA group, n=837). In the HSA group, bupivacaine and morphine were intrathecally administered immediately before GA was induced. Outcomes included fast-track extubation (less than 6 hours), extubation in the operating room, fast-track discharge from the intensive care unit (ICU) (less than 48 hours) and hospital (less than 7 days).
Results:
In the HSA group, 60.1% were extubated in less than 6 hours after ICU admission, as compared with 39.9% in the GA group (p<0.001). In the HSA group, 33.0% were extubated in the operating room, as compared with 4.4% in the GA group (p<0.001). LOS in the ICU was less than 48 hours in 67.6% in the HSA group, as compared with 57.2% of those in the GA group (p=0.033). LOS in the hospital was less than 7 days in 63.3% in the HSA group, as compared with 53.5% in the GA group (p=0.084).
Conclusions:
HSA technique combined with GA in cardiac surgery increased the rate of fast-track extubation (less than 6 hours) when compared with GA only.
More Related Videos
Related Concept Videos
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:22Aneurysm IV: Nursing Management