Spinal anesthesia increases the frequency of extubation in the operating room and decreases the time of mechanical ventilation after cardiac surgery

Abstract Introduction: The delayed extubation of patients undergoing mechanical ventilation (MV) in the postoperative period of cardiac surgery (CS) is associated with mortality. The adoption of spinal anesthesia (SA) combined with general anesthesia in CS influences the orotracheal intubation time (OIT). This study aims to verify if the adoption of SA reduces the time of MV after CS, compared to general anesthesia (GA) alone. Methods: Two hundred and seventeen CS patients were divided into two groups. The GA group included 108 patients (age: 56±1 years, 66 males) and the SA group included 109 patients (age: 60±13 years, 55 males). Patients were weaned from MV and, after clinical evaluation, extubated. Results: In the SA group, considering a 13-month period, 24% of the patients were extubated in the operating room (OR), compared to 10% in the GA group (P=0.00). The OIT was lower in the SA group than in the GA group (SA: 4.4±5.9 hours vs. GA: 6.0±5.6 hours, P=0.04). In July/2017, where all surgeries were performed in the GA regimen, only 7.1% of the patients were extubated in the OR. In July/2018, 94% of the surgeries were performed under SA, and 64.7% of the patients were extubated in the OR (P=0.00). The OIT on arrival at the intensive care unit to extubation, comparing July/2017 to July/2018, was 5.3±5.3 hours in the GA group vs. 1.7±3.9 hours in the SA group (P=0.04). Conclusion: The adoption of SA in CS increased the frequency of extubations in the OR and decreased OIT and MV time.

Spinal Anesthesia Increases the Frequency of Extubation in the Operating Room and Decreases the Time of Mechanical Ventilation after Cardiac Surgery.

INTRODUCTION: The delayed extubation of patients undergoing mechanical ventilation (MV) in the postoperative period of cardiac surgery (CS) is associated with mortality. The adoption of spinal anesthesia (SA) combined with general anesthesia in CS influences the orotracheal intubation time (OIT). This study aims to verify if the adoption of SA reduces the time of MV after CS, compared to general anesthesia (GA) alone. METHODS: Two hundred and seventeen CS patients were divided into two groups. The GA group included 108 patients (age: 56±1 years, 66 males) and the SA group included 109 patients (age: 60±13 years, 55 males). Patients were weaned from MV and, after clinical evaluation, extubated. RESULTS: In the SA group, considering a 13-month period, 24% of the patients were extubated in the operating room (OR), compared to 10% in the GA group (P=0.00). The OIT was lower in the SA group than in the GA group (SA: 4.4±5.9 hours vs. GA: 6.0±5.6 hours, P=0.04). In July/2017, where all surgeries were performed in the GA regimen, only 7.1% of the patients were extubated in the OR. In July/2018, 94% of the surgeries were performed under SA, and 64.7% of the patients were extubated in the OR (P=0.00). The OIT on arrival at the intensive care unit to extubation, comparing July/2017 to July/2018, was 5.3±5.3 hours in the GA group vs. 1.7±3.9 hours in the SA group (P=0.04). CONCLUSION: The adoption of SA in CS increased the frequency of extubations in the OR and decreased OIT and MV time.

Estudo piloto da viabilidade no uso de cicloergômetro para membros superiores no primeiro dia pós-operatório de cirurgia cardíaca / Pilot study of viability in the use of cycle ergometer for upper limbs on the first postoperative day of cardiac surgery

INTRODUÇÃO: O uso do cicloergômetro para os membros superiores pode contribuir para manter a capacidade funcional em pacientes após cirurgia cardíaca (CC). OBJETIVOS: Investigar as respostas cardiorrespiratórias de pacientes após CC recebendo ou não drogas vasoativas (DVAs) durante a realização de cicloergômetro para membros superiores, verificando a incidência de perda de cateter arterial radial ou de fraturas de fios de aço no esterno. MATERIAL E MÉTODOS: Estudo piloto envolvendo 26 pacientes divididos em 2 grupos. Grupo CO: sem uso de DVAs (13 pacientes, idade: 57 ± 12 anos, 09 homens) e grupo DVA: (13 pacientes, idade: 61 ± 10 anos, 07 homens), submetidos à CC, que no 1ºPO realizaram o cicloergômetro para membros superiores. Os parâmetros avaliados durante o exercício foram frequência cardíaca (FC), saturação de oxigênio (SpO2), dispneia, fadiga de membros superiores e pressão arterial média (PAM). A incidência de perdas do cateter da artéria radial ou de fraturas de fios de aço no esterno foi avaliada. A análise estatística adotou análise de variância de um ou dois caminhos, com post hoc de Newman Kauls ou Scheffé, quando necessário. O valor de significância foi 0,05%. RESULTADOS: a FC aumentou nos dois grupos ao final do exercício (p = 0,00), sem diferença (p = 0,97); SpO2, dispneia e PAM não se alteraram do repouso para o final do exercício (p = 0,49; p = 0,78 e p = 0,25, respectivamente); A fadiga nos membros superiores aumentou em ambos os grupos (p = 0,04); Não houve eventos de perda do cateter de artéria radial ou de fraturas de fios de aço no esterno. CONCLUSÃO: A adoção do cicloergômetro para membros superiores mostrou-se segura no 1ºPO de CC, mesmo nos indivíduos que utilizaram DVAs. Não houve relação entre o uso do cicloergômetro dos membros superiores e a perda de cateteres arteriais ou de fraturas de fios de aço no esterno.

INTRODUCTION: The use of a cycle ergometer for the upper limbs may contribute to maintain the functional capacity in patients after heart surgery (HS). OBJECTIVES: To investigate the cardiorespiratory responses of HS patients receiving or not vasoactive drugs (VADs) during the realizations of cycle ergometer for upper limbs, verifying the incidence of loss of radial arterial catheter or of steel wire fractures in the sternum. MATERIAL AND METHODS: A pilot study involving 26 patients divided in 2 groups. Group CO: no use of VADs (13 patients, age: 57±12 years, 09 male) and VAD group: (13 patients, age: 61±10 years, 07 male), submitted to HS, which on the first postoperative day (1stPO) performed the cycle ergometer for upper limbs. The parameters evaluated during the exercise were heart rate (HR), oxygen saturation (SpO2), dyspnea, fatigue of upper limbs and mean arterial pressure (MAP). The incidence of losses of the radial artery catheter and of steel wire fractures in the sternum was calculated. Statistical analysis adopted one-way or two-way analysis of variance, with post hoc from Newman Kauls or Scheffé, when necessary. The significance level was 0.05%. RESULTS: HR increased in both groups at the end of the exercise (p = 0.00), with no difference (p=0.97); SpO2, dyspnea and MAP did not change from rest to the end of exercise (p=0.49; p=0.78 and p=0.25, respectively); The fatigue in the upper limbs increased in both groups (p=0.04), without difference between groups (p=0.79); There was no event of loss of radial artery catheter or steel wire fractures in the sternum. CONCLUSION: The adoption of the cycle ergometer for upper limbs was safe in sthe 1stPO of HS, even in the individuals using VADs. There was no relationship between the use of the upper limbs cycle ergometer and losses of arterial catheters or steel wire fractures in the sternum.