Early extubation after elective mitral valve surgery

LETTERS TO THE EDITOR

Early Extubation After Elective Mitral Valve Surgery To the Editor: Dr D'Attelis et al ~ are surely exaggerating when they write that the routine use of postoperative ventilatory support after cardiac surgery has been an indispensable condition in all centers over the last 30 years. They quote Quasha et al, 2 who showed that early extubation was safe for coronary artery bypass surgery in 1980 and then imply that this dramatic change, attributable to improvements in cardiopulmonary bypass techniques and anesthetic management, is a recent development. A cursory look at the relevant literature suggests that early extubation was not uncommon more than a decade ago. 3-n

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Fig 1. Extubation time after mitral valve surgery: 15 patients; mean, 231 _+ 50 min.

Dr D'Attelis et al's anesthetic technique for the 15 patients in their study is, of course, another interesting variation. To describe the mean time to spontaneous respiration as approximately 2 hours 50 minutes with endotracheal extubation occurring 30 to 60 minutes later, although statistically correct, is rather misleading, as shown by Fig 1 (derived from Table 3 of the manuscript). I suggest that routine use of postoperative ventilatory support has not been the sine qua non of care in all centers for many years, but respiratory care has been a matter of chacun ~ son gout.

J.M. Manners, MD Wessex Cardiothoracic Centre Southampton, U K

REFERENCES 1. D'Attelis N, Nicolas-Robin A, Delayance S, et al: Early extubaLion after mitral valve surgery: A target-controlled infusion of propofol and low-dose sufentanil. J Cardiothorac Vasc Anesth 11:467-473, 1997 2. Quasha AL, Lober N, Feeley TW, et al: Postoperative respiratory care: A controlled trial of early and late extubation following coronary artery bypass grafting. Anesthesiology 52:135-141, 1980 3. Midell AI, Skinner DB, De Boer A, Bermurdez G: A review of pulmonary problems following valve replacement in 100 consecutive patients. Ann Thorac Surg 18:219-227, 1974 4. Klineberg PL, Greer RJ, Hirsh RA, Aukburg SJ: Early exmbation after coronary artery bypass grafting. Crit Care Med 5:272-274, 1977 5. Prakash O, Jonson B, Meij S, et al: Criteria for early exmbation after intracardiac surgery in adults. Anesth Analg 56:703-708, 1977 6. Hazrati S: Maintaining spontaneous respiration in the postoperative phase of cardiac surgery. Int Surg 62:199-200, 1977

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7. Manners JM: Anaesthesia for cardiac surgery, in Norman J, Whitwam JG (eds): Topical Reviews in Anaesthesia. Bristol: Wright, 1980, pp 179-260 8. Manners JM, Monro JL, Edwards JC: Corrective cardiac surgery in infants. Anaesthesia 35:1149-1156, 1980 9. Lichtenthal PR, Wade LD, Niemyski PR, Shapiro BA: Respiratory management after cardiac surgery with inhalational anesthesia. Crit Care Med 11:603-605, 1983 10. Schuller JL, Bovill JG, Nijveld A, et al: Early extubation of the trachea after open heart surgery for congenital heart disease. Br J Anaesth 56:1101-1108, 1984 11. Aps C, Hutter JA, Williams BT: Anaesthetic management and postoperative care of cardiac surgical patients in a general recovery ward. Anaesthesia 41:533-537, 1986

Journal o f Cardiothoracic and Vascular Anesthesia,

Vo112,No2 (April),1998:pp 238-242