Thoracic Epidural Anesthesia for Cardiac Surgery: The Effects on Tracheal Intubation Time and Length of Hospital Stay

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Abstract
Mobilization were altered to facilitate early intensive care discharge and hospital discharge. Fifty patients received high (T1 to T4) thoracic epidural anesthesia (TEA) with ropivacaine 1% (4-mL bolus, 3–5 mL/h infusion), with fentanyl (100-μg bolus, 15–25 μg/h infusion) and a propofol infusion (6 mg · kg−1 · h−1). Another 50 patients (the General Anesthesia group) received fentanyl 15 μg/kg and propofol (5 mg · kg−1 · h−1), followed by IV morphine patient-controlled analgesia. The TEA group had lower visual analog scores with coughing postextubation (median, 0 vs 26 mm;P < 0.0001) and were extubated earlier (median hours [interquartile range], 3.2 [2.1–4.6] vs 6.7 [3.3–13.2];P < 0.0001). More than half of all patients were discharged home on Postoperative Day 4 (24%) or 5 (33%), but there was no difference in the length of stay between the TEA group (median [interquartile range], Day 5 [5–6]) and the General Anesthesia group (median [interquartile range], Day 5 [4–7]). There were no differences in postoperative spirometry or chest radiograph changes or in markers for postoperative myocardial ischemia or infarction. No significant TEA-related complications occurred. In summary, TEA provided better analgesia and allowed earlier tracheal extubation but did not reduce the length of hospital stay after coronary artery surgery....

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