Postoperative respiratory care: a controlled trial of early and late extubation following coronary-artery bypass grafting.

Sequelae of early versus late extubation of the trachea in patients following coronary-artery bypass grafting were compared prospectively in 38 patients randomly assigned to one of the two groups. The times to extubation were 2 +/- 2 and 18 +/- 3 hours after operation for the two groups. Comparisons were made between groups for the following five variables: time spent in the intensive care unit; drug utilization in the intensive care unit; cardiopulmonary morbidity; hemodynamic performance; patient stress (plasma norepinephrine levels). The anesthetic technique consisted of induction with thiopental, nitrous oxide, and halothane, followed by maintenance with nitrous oxide and halothane. Pancuronium was the only muscle relaxant administered. Patients whose tracheas were extubated early had muscle relaxants reversed prior to the application of extubation criteria. There was no significant difference between the groups in times spent in the intensive care unit, hemodynamic performances, or plasma norepinephrine levels; however, the patients whose tracheas were extubated early received less morphine and diazepam and suffered significantly less cardiopulmonary morbidity.