Respiratory management after cardiac surgery with inhalation anesthesia

Improvements in cardiac surgery techniques and anesthetic management have given us cause to re-evaluate the necessity for postoperative mechanical ventilation and delayed extubation after open-heart surgery with inhalational anesthesia. One hundred consecutive patients undergoing various types of cardiac surgery were entered into this study; 94 patients met the requirements for spontaneous ventilation in the immediate postoperative time period and mechanical ventilation was not utilized. Of these 94 patients, 40 (45%) met extubation requirements within 90 min and were subsequently extubated. No patient required reintubation. Six (6%) patients failed to meet the requirements for spontaneous ventilation and, therefore, required mechanical ventilatory assistance postoperatively. In the majority of cardiac patients, the anesthetic technique determines postoperative ventilatory needs. Very poor preoperative physical status and unusually long procedures, however, will probably preclude early extubation or spontaneous ventilation and dictate the need for mechanical ventilation regardless of the anesthetic technique.