RECOVERY PROFILE AND HEMODYNAMIC EFFECTS OF FAST TRACK CARDIAC ANESTHESIA: USE OF SUBARACHNOID MORPHINE COMBINED WITH PROPOFOL BASED OR SEVOFLURANE BASED ANESTHESIA

Fast track cardiac anesthetic techniques can lead to earlier tracheal extubation, decrease risk of post-operative hypertension and arrhythmias, and shorter intensive care unit stays. The aim of this study is to evaluate the use of subarachnoid morphine combined with propofol based or sevoflurane based anesthesia for CABG surgery regarding hemodynamic changes and time of tracheal extubation in term of fast track extubation. Methods: Preoperative 8 □g/kg of morphine was injected into the subarachnoid space in 60 patients. The patients were randomly divided into two equal groups. In group I, anesthesia was inducted and maintained with sevoflurane. In group II, anesthesia was inducted and maintained with propofol. Patients were extubated in the intensive care unit using predefined extubation criteria. Hemodynamic parameters were measured during operation and in ICU. Arterial blood gases, 12 lead ECG was done, assessment of pain and sedation scores and extubation time were recorded in ICU. Results: In both groups, during the induction period there were decreases in HR and MBP. As regard MBP, there were a highly significant statistical differences between the two groups during the post-induction and before CPB. The extubation times were 4.8 ± 0.5 h and 5.35 ± 0.55 h in the group I and group II, respectively with no statistical differences. There was no statistical difference between the two groups as regard pain and sedation scores, ABGs and the incidence of myocardial ischemia by ECG. The mean duration of ICU stay in group I (14.2 ± 0.45 h) was no statistical different than in group II (14.5 ± 0.35 h). Conclusion: Early tracheal extubation, using subarachnoid morphine combined with propofol based or sevoflurane based fast track anesthesia, is a safe techniques give effective control of postoperative pain without compromising intraoperative hemodynamic stability.