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Impact of high spinal anesthesia technique on fast-track strategy in cardiac surgery: retrospective study
  1. Satoshi Hanada1,
  2. Atsushi Kurosawa2,
  3. Benjamin Randall3,
  4. Theodore Van Der Horst4 and
  5. Kenichi Ueda1
  1. 1 Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
  3. 3 Mountain West Anesthesia, Intermountain Medical Center, Murray, Utah, USA
  4. 4 Department of Anesthesia and Perioperative Medicine, Mayo Clinic Health System, La Crosse, Wisconsin, USA
  1. Correspondence to Dr Kenichi Ueda, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; kenichi-ueda{at}


Background and objectives Although high spinal anesthesia (HSA) has been used in cardiac surgery, the technique has not yet been widely accepted. This retrospective study was designed to investigate the impact of HSA technique on fast-track strategy in cardiac surgery.

Methods Elective cardiac surgery cases (n=1025) were divided into two groups: cases with HSA combined with general anesthesia (GA) (HSA group, n=188) and cases with GA only (GA group, n=837). In the HSA group, bupivacaine and morphine were intrathecally administered immediately before GA was induced. Outcomes included fast-track extubation (less than 6 hours), extubation in the operating room, fast-track discharge from the intensive care unit (ICU) (less than 48 hours) and hospital (less than 7 days).

Results In the HSA group, 60.1% were extubated in less than 6 hours after ICU admission, as compared with 39.9% in the GA group (p<0.001). In the HSA group, 33.0% were extubated in the operating room, as compared with 4.4% in the GA group (p<0.001). LOS in the ICU was less than 48 hours in 67.6% in the HSA group, as compared with 57.2% of those in the GA group (p=0.033). LOS in the hospital was less than 7 days in 63.3% in the HSA group, as compared with 53.5% in the GA group (p=0.084).

Conclusions HSA technique combined with GA in cardiac surgery increased the rate of fast-track extubation (less than 6 hours) when compared with GA only.

  • neuraxial blocks: spinal
  • regional anesthesia
  • surgical outcome

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  • Presented at Interim data from this work were presented at the American Society of Anesthesiologists annual meeting in San Francisco, California, in October 2013.

  • Contributors SH and AK: substantial contribution to the acquisition and interpretation of data and drafting of the article. BR, TV and KU: substantial contribution to conception and design, acquisition and interpretation of data. KU: substantial contribution to the drafting of the article.

  • Funding This study was funded by the Department of Anesthesia at the University of Iowa Hospitals and Clinics. This study was also supported in part by the University of Iowa Clinical and Translational Science Award granted with funds from the National Institutes of Health (UL1TR002537).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This retrospective study was approved by the University of Iowa Institutional Review Board (IRB) (IRB number 201205751).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.