On-Table Extubation After Off-Pump Coronary Artery Bypass: A Step Forward to Fast-Track Recovery

On-table extubation following coronary artery bypass grafting (CABG) surgery has garnered attention owing to its potential to enhance postoperative recovery and reduce resource utilization. Traditional approaches often involve extended mechanical ventilation, which can delay discharge from the intensive care unit (ICU) and increase the risk of complications. This case report assessed the feasibility and outcomes of on-table extubation in a patient undergoing beating heart CABG. A 42-year-old male with triple vessel disease underwent beating heart CABG under a combination of general and regional anaesthesia, including an erector spinae plane block (ESPB) at the T4 level for analgesia. Standard monitoring and anaesthetic protocols were adhered to, with careful titration of opioids and inotropes. Three grafts were placed: the left internal mammary artery (LIMA) to the left anterior descending artery (LAD), the reversed saphenous vein graft (RSVG) to the obtuse marginal artery 1 (OM1), and the RSVG to the posterior descending artery (PDA). Extubation was performed immediately after surgery based on the following predefined criteria: patient alertness, stable hemodynamics, and adequate oxygenation. The patient was successfully extubated in the operating room with stable vital signs (blood pressure 110/70 mmHg, heart rate 96 beats per minute, SpO₂ >95%). Postoperative chest radiography and blood gas analysis revealed no abnormalities, and drain collection was minimal (300 mL on postoperative day 1). The patient was discharged on the eighth postoperative day without complications, demonstrating the safety and efficacy of on-table extubation. This case supports the growing body of evidence that on-table extubation after CABG is safe and beneficial, reducing ICU stays and resource utilization without increasing the risks of reintubation or readmission. ESPB contributes to effective analgesia and hemodynamic stability, thereby facilitating early extubation. These findings are consistent with recent studies advocating early extubation protocols in cardiac surgery to improve recovery and patient outcomes.