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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2009 October;22(5):211-5
Fast-track alfentanil-based general anesthesia for valve surgery. Review of our first 100 patients without thoracic epidural analgesia
Vanek T., Straka Z., Brucek P., Jares M., Votava J., Jirasek K.
Department of Cardiac Surgery, 3rd Medical School of Charles University, Kralovske Vinohrady University Hospital, Prague, Czech Republic
Aim. To report the experience gained with alfentanil based fast-track general anesthesia without epidural catheter insertion for heart valve / aorta surgery.
Methods. One hundred unselected patients undergoing elective valve surgery (15 low risk patients with EuroSCORE 0-2, 39 medium risk patients with EuroSCORE 3-5, 46 high risk patients with EuroSCORE 6 plus) of a consecutive series, were anesthetized by general anesthesia based on alfentanil, midazolam, isoflurane and atracurium.
Results. The average total dose of alfentanil per procedure was 10.5 ± 3.4 mg, i.e., 134±36 µg/kg. Eighty-four (84%) patients (i.e. 14 [93.3%] low risk patients, 33 [84.6%] medium risk patients, 37 [80.4%] high risk patients) were extubated within up to 30 minutes from the end of surgery. Fifty-eight out of these patients were extubated in the operating room less than 10 minutes after skin closure and 26 were extubated in the intensive care unit. One patient was reintubated and ventilated for a further 24 hours because of transient cerebral ischemia. Five (5%) patients were reintubated because of the need for early surgical re-exploration due to postoperative bleeding or cardiac tamponade. Two (2%) high risk patients died of heart failure without any attempt at extubation. Two (2%) non-extubated patients with chronic obstructive pulmonary disease were transferred to another department / hospital for prolonged ventilatory support. Mean intensive care unit length of stay was 1.8±1.8 days, 10 patients (of those extubated within 30 minutes) were discharged from the intensive care unit on day 0.
Conclusion. Fast-track general anesthesia based on alfentanil seems to be safe, readily reproducible and can be recommended for on-pump procedures as well as for high risk patients.