Early Outcome of Fast-track Extubation in Opium Addicted Patients after Off pump Coronary Artery Bypass Graft

Background:

Researchers have tried to determine a clinical Fast-Track Extubation (FTE) for an efficient and safe approach to post-operative management in high-risk patients undergoing cardiac surgery. Opium consumption is one of the risk factors for coronary artery disease and is more prevalent among the patients with heart problems.

Objective:

The present study aimed to determine the early outcomes of FTE in opium addicted patients after Off-Pump Coronary Artery Bypass Graft (OPCABG) surgery.

Methods:

This single-centered retrospective cohort study was conducted on the patients who had undergone OPCABG between February 2008 and February 2011. The patients were divided into opium-negative and opium-positive groups. The patients were prepared for rapid recovery, emphasizing pre-operative physiotherapy, respiratory training, low dose fentanyl anesthesia, diuretic use, and autologous blood salvage to avoid the untoward effects of allogenic blood transfusion. Significant factors in successful FTE were analyzed by multivariate regression analysis. P-values less than 0.05 were considered to be statistically significant.

Results:

Mortality was higher among the opium addicted patients (P = 0.007). Most of the patients with extubation time > 12 hours were opium addicted (P < 0.001). The results of multivariate regression analysis showed that age, gender, post-operative Myocardial Infarction (MI), smoking, extubation time, transfusion, and post-operative renal complications were the significant predictors of extubation time in the opium addicted patients.

Conclusion:

FTE could be successfully performed in most of the patients undergoing OPCABG. Managing addicted patients and making effort to control post-operative MI, renal complications, smoking, and extubation time are important issues for a successful FTE.