Early extubation after cardiac surgery: Emotional status in the early postoperative period

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 15; no. 4; pp. 439 - 444
• Main Authors: Silbert, Brendan S., Santamaria, John D., Kelly, William J., O'Brien, Jennifer L., Blyth, Carolyn M., Wong, Maggie Y., Allen, Nicholas B.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.08.2001; Elsevier
• Subjects: Affect; Biological and medical sciences; cardiac surgery; Coronary Artery Bypass - psychology; Depression - diagnosis; Depression - etiology; emotional status; Emotions; fast-track anaesthesia; Female; Humans; Intubation, Intratracheal - psychology; Male; Medical sciences; Middle Aged; Postoperative Period; Prospective Studies; Psychiatric Status Rating Scales; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; fast-track anaesthesia; emotional status; cardiac surgery; Human; Postoperative; Treatment; Aortocoronary; Bypass; Surgery; Cardiovascular disease; Technique; Coronary heart disease; Resuscitation; Extubation; Stress
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/jcan.2001.24978

Objective: To compare the emotional state during the first 3 days after coronary artery surgery of patients who had undergone early versus conventional extubation. Design: A prospective, randomized, controlled trial. Setting: University hospital, single center. Participants: Eligible patients (n = 100) presenting for elective coronary artery surgery, randomized to an early extubation group or a conventional extubation group. Interventions: Emotional status was measured by the Hospital Anxiety and Depression Scale (HAD), the Self Assessment Manikin (SAM), and the Multiple Affect Adjective Check List-Revised (MAACL-R). Tests were administered preoperatively and on the 1st and 3rd days postoperatively. Measurements and Main Results: Of patients in the conventional extubation group, 30% showed moderate-to-severe depressive symptoms (HAD score >10) on day 3 postoperatively compared with 8% of patients in the early extubation group (p = 0.02). There was a clinically insignificant increase in MAACL-R depression score on the 1st postoperative day within both groups but no other differences within or between groups in SAM or MAACL-R scores. Conclusion: Early extubation results in fewer patients displaying depressive symptoms on the 3rd postoperative day but appears to have little effect on other measurements of emotional status. Anesthetic management during coronary artery bypass graft surgery may play an important role in the overall well-being of the patient by decreasing the incidence of postoperative depression. Copyright © 2001 by W.B. Saunders Company