The Article”>17Masoumi, MohammadShahesmaeili, ArmitaMirzazadeh, AliTavakoli, MarjanAli, Arghavan

The word ‘Opium’ is a Latin word, meaning “Juice”. It is obtained as a white resin from the incised unripe fruit of the poppy plant Papaver somniferous ADDIN EN.CITE <EndNote><Cite><Author>Rastogi</Author><Year>1997</Year><RecNum>102</RecNum><DisplayText>1</DisplayText><record><rec-number>102</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>102</key></foreign-keys><ref-type name=”Book”>6</ref-type><contributors><authors><author>Rastogi, VB</author></authors></contributors><titles><title>Modern Biology</title></titles><dates><year>1997</year></dates><publisher>Pitambar Publishing</publisher><isbn>8120904966</isbn><urls></urls></record></Cite></EndNote>1. Prevalence of opium addiction is high in coronary artery disease (CAD) ADDIN EN.CITE <EndNote><Cite><Author>Masoumi</Author><Year>2010</Year><RecNum>104</RecNum><DisplayText>2</DisplayText><record><rec-number>104</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>104</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Masoumi, Mohammad</author><author>Shahesmaeili, Armita</author><author>Mirzazadeh, Ali</author><author>Tavakoli, Marjan</author><author>Ali, Arghavan Zia</author></authors></contributors><titles><title>Opium addiction and severity of coronary artery disease: a case-control study</title><secondary-title>Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences</secondary-title></titles><periodical><full-title>Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences</full-title></periodical><pages>27</pages><volume>15</volume><number>1</number><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>2, respiratory disease like tuberculosis, chronic obstructive pulmonary disease (COPD), asthma and bronchiectasis cases as where it is used to suppress cough ADDIN EN.

CITE <EndNote><Cite><Author>Morice</Author><Year>2007</Year><RecNum>105</RecNum><DisplayText>3</DisplayText><record><rec-number>105</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>105</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Morice, Alyn H</author><author>Menon, Madhav S</author><author>Mulrennan, Siobhan A</author><author>Everett, Caroline F</author><author>Wright, Caroline</author><author>Jackson, Jennifer</author><author>Thompson, Rachel</author></authors></contributors><titles><title>Opiate therapy in chronic cough</title><secondary-title>American journal of respiratory and critical care medicine</secondary-title></titles><periodical><full-title>American journal of respiratory and critical care medicine</full-title></periodical><pages>312-315</pages><volume>175</volume><number>4</number><dates><year>2007</year></dates><isbn>1073-449X</isbn><urls></urls></record></Cite></EndNote>3. Respiratory disorder is one of the most prevalent complications of coronary artery bypass graft (CABG) surgery 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ADDIN EN.CITE 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ADDIN EN.CITE.DATA 4-6.

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Opium using has been known as a risk factor for CAD and respiratory track disease in several studies 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ADDIN EN.CITE.

DATA 7, 8. Also opium consumption is particularly more prevalent among patients, who have a heart problems. They generally use opium to manage their cardiac disease ADDIN EN.

CITE <EndNote><Cite><Author>Farahani</Author><Year>2015</Year><RecNum>119</RecNum><DisplayText>9</DisplayText><record><rec-number>119</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>119</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Farahani, Mansoureh A</author><author>Ghaffari, Fatemeh</author><author>Fatemi, Naiemeh Seyed</author></authors></contributors><titles><title>Opium addiction in patients with coronary artery disease: a grounded theory study</title><secondary-title>Medical journal of the Islamic Republic of Iran</secondary-title></titles><periodical><full-title>Medical journal of the Islamic Republic of Iran</full-title></periodical><pages>267</pages><volume>29</volume><dates><year>2015</year></dates><urls></urls></record></Cite></EndNote>9. With the advance in anesthesia and surgical technice, fast track extubation (FTE) has increased interest, according to the possibility of reducing health costs seemingly without compromising patient care ADDIN EN.CITE <EndNote><Cite><Author>Reis</Author><Year>2002</Year><RecNum>111</RecNum><DisplayText>10</DisplayText><record><rec-number>111</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>111</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Reis, J</author><author>Mota, JC</author><author>Ponce, P</author><author>Costa-Pereira, A</author><author>Guerreiro, M</author></authors></contributors><titles><title>Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass</title><secondary-title>European journal of cardio-thoracic surgery</secondary-title></titles><periodical><full-title>European journal of cardio-thoracic surgery</full-title></periodical><pages>1026-1030</pages><volume>21</volume><number>6</number><dates><year>2002</year></dates><isbn>1873-734X</isbn><urls></urls></record></Cite></EndNote>10. This approach was first applied in 1990s, when insurance system focused greater benefit on possibility of methods for reducing cost and improve hospital efficiency ADDIN EN.CITE <EndNote><Cite><Author>Hawkes</Author><Year>2010</Year><RecNum>112</RecNum><DisplayText>11, 12</DisplayText><record><rec-number>112</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>112</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Hawkes, Claire</author><author>Foxcroft, David R</author><author>Yerrell, Paul</author></authors></contributors><titles><title>Clinical guideline for nurse?led early extubation after coronary artery bypass: an evaluation</title><secondary-title>Journal of advanced nursing</secondary-title></titles><periodical><full-title>Journal of advanced nursing</full-title></periodical><pages>2038-2049</pages><volume>66</volume><number>9</number><dates><year>2010</year></dates><isbn>0309-2402</isbn><urls></urls></record></Cite><Cite><Author>Pande</Author><Year>2003</Year><RecNum>113</RecNum><record><rec-number>113</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>113</key></foreign-keys><ref-type name=”Conference Proceedings”>10</ref-type><contributors><authors><author>Pande, RU</author><author>Nader, ND</author><author>Donias, HW</author><author>D&apos;Ancona, G</author><author>Karamanoukian, HL</author></authors></contributors><titles><title>Fast-Tracking Cardiac Surgery</title><secondary-title>The heart surgery forum</secondary-title></titles><pages>244-248</pages><volume>6</volume><number>4</number><dates><year>2003</year></dates><isbn>1098-3511</isbn><urls></urls></record></Cite></EndNote>11, 12.

The advantages of FTE after cardiac surgery have been well established ADDIN EN.CITE <EndNote><Cite><Author>Cheng</Author><Year>1996</Year><RecNum>114</RecNum><DisplayText>13</DisplayText><record><rec-number>114</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>114</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Cheng, Davy CH</author><author>Karski, Jacek</author><author>Peniston, Charles</author><author>Raveendran, Ganesh</author><author>Asokumar, Buvanendran</author><author>Carroll, Jo</author><author>David, Tirone</author><author>Sandler, Alan</author></authors></contributors><titles><title>Early Tracheal Extubation after Coronary Artery Bypass Graft Surgery Reduces Costs and Improves Resource UseA Prospective, Randomized, Controlled Trial</title><secondary-title>Anesthesiology: The Journal of the American Society of Anesthesiologists</secondary-title></titles><periodical><full-title>Anesthesiology: The Journal of the American Society of Anesthesiologists</full-title></periodical><pages>1300-1310.</pages><volume>85</volume><number>6</number><dates><year>1996</year></dates><isbn>0003-3022</isbn><urls></urls></record></Cite></EndNote>13. Many investigators 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ADDIN EN.CITE 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bD48cGFnZXM+SUk0MS01PC9wYWdlcz48dm9sdW1lPjk4PC92b2x1bWU+PG51bWJlcj4xOSBTdXBwbDwvbnVtYmVyPjxkYXRlcz48eWVhcj4xOTk4PC95ZWFyPjwvZGF0ZXM+PGlzYm4+MDAwOS03MzIyPC9pc2JuPjx1cmxzPjwvdXJscz48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn== ADDIN EN.

CITE.DATA 14-17 tried to find a clinical fast-track pathway for an efficient and safe approach to the postoperative management of patients undergoing cardiac surgery. The ability to identify high-risk patients and operative risk factors may help to develop surgical and medical modifications which will allow FTE. Considering the fact that most of the patients who had CAD are opium user and regarding to the relationship between opioid consumption and cardiovascular complication, the present study was performed to determine the early outcome of fast-track extubation in opium addicted patients after off pump coronary artery bypass graft.Methods:Patient population This was a retrospective study of 1489 consecutive patients underwent myocardial revascularization without cardiopulmonary bypass (CPB) between February 2008 until 2011.

This study approved by the ethics committee of Kermanshah University of medical science and patient informed consent was signed. The Study populations comprise of CABG candidate patients. The majority of patients underwent elective surgery and 10 % of them urgent operation. Any patients who had ejection fraction (EF) less than 25 %, congestive heart failure or pulmonary edema during attendance to the intensive care unit (ICU), sever COPD, hemodynamic instability, severs arrhythmia, inotropic drug usage (>5 micro min-1), intra-aortic balloon pump (IABP) insertion, core temperature below 35c, inadequate spontaneous ventilation were excluded. If the postoperative bleeding fulfills criteria for reexploration, the patients explored post-operatively during first 3-4 hours and then planned for extubation.

If bleeding occurred late (first 10 hours) after attendance in the ICU, the patients sedated and excluded from the study. The patients with mild or moderate COPD, history of cerebrovascular accident (CVA), seizure, renal failure, elderly patients, recent MI, left bundle branch block, pre-operative unstable angina, emergency operation or liver disease were not excluded. Radial arterial pressure and central venous pressure from subclavian vein were monitored in all patients. Next morning the mediastinal drains, venous and arterial lines were removed.

The patients who, having clear fluids sitting in bed transferred to the ward. From the second post-operative day, the patients were usually allowed to move freely in surgical ward. The definition of a fully mobile patient was made when she or he was able to climb stairs or work outdoors without assistance.Surgical technique:The day before operation, the patients were educated by an experienced nurse to manage post-operative positive pressure respiration, coughing, pulmonary toilet or respiratory physiotherapy. Furthermore, detailed instructions for chest physiotherapy were given.

After the patients stayed in the ICU, FTE planned for all enrolled patients. The anesthetic operation technique was selected toward facilitating FTE regardless of pre-operative morbidity condition. The induction was started by continuous infusion of fentanyl and followed by single shot of atracurium for muscle paralysis. Anesthesia was then maintained by further continuous fentanyl and by inhaled isoflurane with an oxygen and air mixture of at 1:1 ratio.

Continuous atracurium was administrated for muscle relaxation. Serial electrocardiograms and estimation of serum creatinine phosphokinase myocardial band (CPK MB) were assess to detect perioperative ischemia. All patients have been operated on with median sternotomy and using the standard technique of cardiopulmonary bypass with off pump technique, as previously described ADDIN EN.CITE <EndNote><Cite><Author>Sabzi</Author><Year>2017</Year><RecNum>157</RecNum><DisplayText>18, 19</DisplayText><record><rec-number>157</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>157</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Sabzi, Feridoun</author><author>Asadmobini, Atefeh</author><author>Ghasemi, Fahimeh</author></authors></contributors><titles><title>In-Hospital Outcome of Patients Undergoing off-Pump Coronary Artery Bypass Graft With and Without Coronary Endarterectomy</title><secondary-title>Research in Cardiovascular Medicine</secondary-title></titles><periodical><full-title>Research in Cardiovascular Medicine</full-title></periodical><pages>4</pages><volume>6</volume><number>2</number><dates><year>2017</year></dates><isbn>2251-9572</isbn><urls></urls></record></Cite><Cite><Author>Sabzi</Author><Year>2012</Year><RecNum>158</RecNum><record><rec-number>158</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>158</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Sabzi, Feridoun</author><author>Hemati, Naser</author><author>Zokaei, Abdoul Hamid</author><author>Moradi, Gholamreza</author><author>Dabiri, Samsam</author></authors></contributors><titles><title>Off-pump coronary bypass grafting causing stunned myocardium</title><secondary-title>The Journal of Tehran University Heart Center</secondary-title></titles><periodical><full-title>The Journal of Tehran University Heart Center</full-title></periodical><pages>143</pages><volume>7</volume><number>3</number><dates><year>2012</year></dates><urls></urls></record></Cite></EndNote>18, 19.Anesthesia: The anesthesia protocol was designed to permit FTE and included a combination of midazolam (0.

1 mg kg-1), fentanyl (5 mg kg-1) and pancuronium supplemented with isoflurane. Hypertension was controlled by trinitroglycerin and tachycardia by application of esmolol. Intra-operative monitoring included an electrocardiograph with ST segment analysis, continuous arterial blood pressure measurement, intermittent blood gas analysis and measurement of body temperature. The following criteria for extubation were used: The patient should be awake and responsive, satisfactory blood gases (PO2 60 mmHg, PCO2 < 45 mmHg), adequate spontaneous ventilation based on clinical ventilation, stable hemodynamic with no or minimum inotropic drugs, chest tube drainage less than 100 ml per hour. Anesthesia was gradually reduced and terminated after transfer to ICU. For pain management diclofenac was administrated as a suppository.

Normothermia of patients was secured by increasing the room temperature and using heating mattress. Contraindications for immediate postoperative extubation were congestive heart failure, core temperature below 35c, and inadequate spontaneous ventilation. Statistical analysis Data has been presented as mean ± SD.

Discrete variables were summarized by percentages. Multiple linear regression analysis was used to predict variables associated with early or prolonged extubation. The patients also divided with respect to their extubation times into two groups, 12? and > 12 hours. Important variables with p-value less than 0.1 in univariate analysis, entered in logistic regression analysis.

P-Value less than 0.05 was considered significant. Discussion: FTE after cardiac surgery reduces the length of ICU or hospital stay and causes an improvement in the intrapulmonary shunt fraction after extubation. Diagnosis of high-risk patients and risk factors make it possible to change the surgical procedure in order to accelerate the extubation time. In this study, we found a significant association between opium addiction and delay in the extubation time.

The results of the present study showed that age and EF was lower in opium addicted patients compare with non–addicted patients. As illustrated in table 4, lower amounts of EF and higher opium usage increase duration of the extubation time. It has been reported in previous study opium addiction reduces the average of age in heart disease ADDIN EN.

CITE <EndNote><Cite><Author>Reece</Author><Year>2014</Year><RecNum>133</RecNum><DisplayText>20</DisplayText><record><rec-number>133</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>133</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Reece, Albert Stuart</author><author>Hulse, Gary Kenneth</author></authors></contributors><titles><title>Impact of lifetime opioid exposure on arterial stiffness and vascular age: cross-sectional and longitudinal studies in men and women</title><secondary-title>Bmj Open</secondary-title></titles><periodical><full-title>Bmj Open</full-title></periodical><pages>e004521</pages><volume>4</volume><number>6</number><dates><year>2014</year></dates><isbn>2044-6055</isbn><urls></urls></record></Cite></EndNote>20. Wong et al reported that advanced age, gender, IABP, inotropes, excessive bleeding and atrial arrhythmia are risk factors of delayed extubation time ADDIN EN.CITE <EndNote><Cite><Author>Wong</Author><Year>1999</Year><RecNum>134</RecNum><DisplayText>21</DisplayText><record><rec-number>134</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>134</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Wong, David T</author><author>Cheng, Davy CH</author><author>Kustra, Rafal</author><author>Tibshirani, Robert</author><author>Karski, Jacek</author><author>Carroll-Munro, Jo</author><author>Sandler, Alan</author></authors></contributors><titles><title>Risk Factors of Delayed Extubation, Prolonged Length of Stay in the Intensive Care Unit, and Mortality in Patients Undergoing Coronary Artery Bypass Graft with Fast-track Cardiac Anesthesia A New Cardiac Risk Score</title><secondary-title>The Journal of the American Society of Anesthesiologists</secondary-title></titles><periodical><full-title>The Journal of the American Society of Anesthesiologists</full-title></periodical><pages>936-936</pages><volume>91</volume><number>4</number><dates><year>1999</year></dates><isbn>0003-3022</isbn><urls></urls></record></Cite></EndNote>21.As illustrated in table 2, the results of the univariate analysis showed that among preoperative variable age, gender, EF, diabetes, preoperative MI, hypertension, COPD, number of grafts, transfusion, IABP, stroke, hospital stay, inotrope use, post-operative apnea have a significant effect on prediction of extubation time. Cheng et al reported that age, inotrope drug, IABP and arrhythmia were predictors of unsuccessful extubation ADDIN EN.

CITE <EndNote><Cite><Author>Cheng</Author><Year>1996</Year><RecNum>120</RecNum><DisplayText>15</DisplayText><record><rec-number>120</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>120</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Cheng, Davy CH</author><author>Karski, Jacek</author><author>Peniston, Charles</author><author>Asokumar, Buvanendran</author><author>Raveendran, Ganesh</author><author>Carroll, Jo</author><author>Nierenberg, Hillary</author><author>Roger, Sandra</author><author>Mickle, Don</author><author>Tong, Jeff</author></authors></contributors><titles><title>Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial</title><secondary-title>The Journal of thoracic and cardiovascular surgery</secondary-title></titles><periodical><full-title>The Journal of Thoracic and Cardiovascular Surgery</full-title></periodical><pages>755-764</pages><volume>112</volume><number>3</number><dates><year>1996</year></dates><isbn>0022-5223</isbn><urls></urls></record></Cite></EndNote>15. Ott R.A. et al ADDIN EN.

CITE <EndNote><Cite><Author>Ott</Author><Year>1997</Year><RecNum>122</RecNum><DisplayText>22</DisplayText><record><rec-number>122</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>122</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Ott, Richard A</author><author>Gutfinger, Dan E</author><author>Miller, Mark P</author><author>Selvan, Arthur</author><author>Codini, Michele A</author><author>Alimadadian, Hossein</author><author>Tanner, Teresa M</author></authors></contributors><titles><title>Coronary artery bypass grafting “on pump”: role of three-day discharge</title><secondary-title>The Annals of thoracic surgery</secondary-title></titles><periodical><full-title>The Annals of thoracic surgery</full-title></periodical><pages>478-481</pages><volume>64</volume><number>2</number><dates><year>1997</year></dates><isbn>0003-4975</isbn><urls></urls></record></Cite></EndNote>22 have described their results in fast-track extubation in elderly patients. They found that age should not be considered as determinants of risk factor for early extubation ADDIN EN.CITE <EndNote><Cite><Author>Ott</Author><Year>1997</Year><RecNum>121</RecNum><DisplayText>22</DisplayText><record><rec-number>121</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>121</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Ott, Richard A</author><author>Gutfinger, Dan E</author><author>Miller, Mark P</author><author>Selvan, Arthur</author><author>Codini, Michele A</author><author>Alimadadian, Hossein</author><author>Tanner, Teresa M</author></authors></contributors><titles><title>Coronary artery bypass grafting “on pump”: role of three-day discharge</title><secondary-title>The Annals of thoracic surgery</secondary-title></titles><periodical><full-title>The Annals of thoracic surgery</full-title></periodical><pages>478-481</pages><volume>64</volume><number>2</number><dates><year>1997</year></dates><isbn>0003-4975</isbn><urls></urls></record></Cite></EndNote>22.

In contrast to these results, our results show that elderly patients (>70 year) had longer extubation time (44.1% > than 12 hours) compared with younger patients (33.7% > 12 hours).

The presence of significant differences in morbidity in our elderly patients compared to similar designed study with on pump method clearly support the benefits of off -pump surgery in older patients. Stroke is an important complication after CABG, and the incidence of stroke in off pump CABG has been reported between 0.3-2 % ADDIN EN.CITE <EndNote><Cite><Author>Chen</Author><Year>2015</Year><RecNum>125</RecNum><DisplayText>23</DisplayText><record><rec-number>125</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>125</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Chen, Jeng-Wei</author><author>Lin, Cheng-Hsin</author><author>Hsu, Ron-Bin</author></authors></contributors><titles><title>Mechanisms of early and delayed stroke after systematic off-pump coronary artery bypass</title><secondary-title>Journal of the Formosan Medical Association</secondary-title></titles><periodical><full-title>Journal of the Formosan Medical Association</full-title></periodical><pages>988-994</pages><volume>114</volume><number>10</number><dates><year>2015</year></dates><isbn>0929-6646</isbn><urls></urls></record></Cite></EndNote>23. Despite preventive efforts, such as Doppler examination of the carotid artery, ascending aorta for calcification, or intra-operative palpation for calcified plaque, this complication is an unavoidable post-surgery event ADDIN EN.

CITE <EndNote><Cite><Author>Fukuda</Author><Year>2000</Year><RecNum>126</RecNum><DisplayText>24</DisplayText><record><rec-number>126</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>126</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Fukuda, Ikuo</author><author>Gomi, Seigo</author><author>Watanabe, Ko</author><author>Seita, Jun</author></authors></contributors><titles><title>Carotid and aortic screening for coronary artery bypass grafting</title><secondary-title>The Annals of thoracic surgery</secondary-title></titles><periodical><full-title>The Annals of thoracic surgery</full-title></periodical><pages>2034-2039</pages><volume>70</volume><number>6</number><dates><year>2000</year></dates><isbn>0003-4975</isbn><urls></urls></record></Cite></EndNote>24. In our study stroke occurred in 3.3% of patients with opium addiction in comparison to 1.4% of non-addicted patients. Our study revealed that preoperative or intraoperative patient profiles and finding are of limited utility in predicting the likelihood of postoperative stroke.

In previous study ADDIN EN.CITE <EndNote><Cite><Author>Kiessling</Author><Year>2013</Year><RecNum>124</RecNum><DisplayText>25</DisplayText><record><rec-number>124</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>124</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Kiessling, Arndt H</author><author>Huneke, Patrick</author><author>Reyher, Christian</author><author>Bingold, Tobias</author><author>Zierer, Andreas</author><author>Moritz, Anton</author></authors></contributors><titles><title>Risk factor analysis for fast track protocol failure</title><secondary-title>Journal of cardiothoracic surgery</secondary-title></titles><periodical><full-title>Journal of cardiothoracic surgery</full-title></periodical><pages>47</pages><volume>8</volume><number>1</number><dates><year>2013</year></dates><isbn>1749-8090</isbn><urls></urls></record></Cite></EndNote>25, increased patient age was the most consistent risk factor for the condition but our study does not confirm this concept. This difference revealed that other unknown factors such as thrombophilia or predisposition of off pump CABG patients to thrombosis or low dose of consumed heparin may explained difference incidence of CVA in younger patients with off pump CABG compared with elderly patients with on pump CABG. Early extubation after the operation is a main step for rapid postoperative recovery and may reduce the need for longer ICU time care due to high dose opioid anesthesia and overnight sedation to a large number of patients. The addicted patients were weaned from ventilator post operatively at a mean of 15.

9 ± 9.8 hours in comparison with 11.5 ± 5.

5 hours in non-addicted patients (P<0.001). The threshold for reexploration was chest tubes drainage 300 ml h-1 for 2 hours or total 1000 ml, to avoid transfusion of large allogeneic blood products.

Therefore, most of the patients were reexplored shortly after the operation and 50% of these patients could be weaned from a ventilator within 6 hours after the initial operation. The impetus for FTE in our center is primarily restricted ICU bed in contrast to others cardiac centers that is economic. Leslie K et al, reported that FTE reduces total costs of CABG by 25% ADDIN EN.CITE <EndNote><Cite><Author>Leslie</Author><Year>1998</Year><RecNum>123</RecNum><DisplayText>26</DisplayText><record><rec-number>123</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>123</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Leslie, Kate</author><author>Sessler, Daniel I</author></authors></contributors><titles><title>The implications of hypothermia for early tracheal extubation following cardiac surgery</title><secondary-title>Journal of cardiothoracic and vascular anesthesia</secondary-title></titles><periodical><full-title>Journal of cardiothoracic and vascular anesthesia</full-title></periodical><pages>30-4; discussion 41-4</pages><volume>12</volume><number>6 Suppl 2</number><dates><year>1998</year></dates><isbn>1053-0770</isbn><urls></urls></record></Cite></EndNote>26. Opium using was one of the important causes of unsuccessful FTE in our patients.

Opium using has not been reported as a risk factor for prolonged intubation time in previous studies. Opium has many component likes codeine, morphine, oxycodon, methadone, and papaverin that its deficit cannot be compensated merely by drugs such as morphine and methadone. Oral use of opium increased its serum level and may be associated with post-operative apnea. FTE is an important step for fast postoperative rehabilitation and may reduce the need for long intensive care to a large number of patients.

Cheng et al ADDIN EN.CITE <EndNote><Cite><Author>Cheng</Author><Year>1996</Year><RecNum>128</RecNum><DisplayText>15</DisplayText><record><rec-number>128</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>128</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Cheng, Davy CH</author><author>Karski, Jacek</author><author>Peniston, Charles</author><author>Asokumar, Buvanendran</author><author>Raveendran, Ganesh</author><author>Carroll, Jo</author><author>Nierenberg, Hillary</author><author>Roger, Sandra</author><author>Mickle, Don</author><author>Tong, Jeff</author></authors></contributors><titles><title>Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial</title><secondary-title>The Journal of thoracic and cardiovascular surgery</secondary-title></titles><periodical><full-title>The Journal of Thoracic and Cardiovascular Surgery</full-title></periodical><pages>755-764</pages><volume>112</volume><number>3</number><dates><year>1996</year></dates><isbn>0022-5223</isbn><urls></urls></record></Cite></EndNote>15, Arom et al ADDIN EN.CITE <EndNote><Cite><Author>Arom</Author><Year>1995</Year><RecNum>129</RecNum><DisplayText>27</DisplayText><record><rec-number>129</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>129</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Arom, Kit V</author><author>Emery, Robert W</author><author>Petersen, Rebecca J</author><author>Schwartz, Marc</author></authors></contributors><titles><title>Cost-effectiveness and predictors of early extubation</title><secondary-title>The Annals of thoracic surgery</secondary-title></titles><periodical><full-title>The Annals of thoracic surgery</full-title></periodical><pages>127-132</pages><volume>60</volume><number>1</number><dates><year>1995</year></dates><isbn>0003-4975</isbn><urls></urls></record></Cite></EndNote>27 and Hickey et al ADDIN EN.CITE <EndNote><Cite><Author>Hickey</Author><Year>1995</Year><RecNum>130</RecNum><DisplayText>28</DisplayText><record><rec-number>130</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>130</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Hickey, Robert F</author><author>Cason, Brian A</author></authors></contributors><titles><title>Timing of tracheal extubation in adult cardiac surgery patients</title><secondary-title>Journal of cardiac surgery</secondary-title></titles><periodical><full-title>Journal of cardiac surgery</full-title></periodical><pages>340-348</pages><volume>10</volume><number>4</number><dates><year>1995</year></dates><isbn>0886-0440</isbn><urls></urls></record></Cite></EndNote>28 have shown that FTE reduce pulmonary complication, encourage earlier mobilization and shortened the hospital stay.

FTE improves post extubation intra pulmonary shunt fraction and may avoid over sedation and the resultant depression of the respiratory center which prolongs the ICU stay ADDIN EN.CITE <EndNote><Cite><Author>Cheng</Author><Year>1996</Year><RecNum>128</RecNum><DisplayText>15</DisplayText><record><rec-number>128</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>128</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Cheng, Davy CH</author><author>Karski, Jacek</author><author>Peniston, Charles</author><author>Asokumar, Buvanendran</author><author>Raveendran, Ganesh</author><author>Carroll, Jo</author><author>Nierenberg, Hillary</author><author>Roger, Sandra</author><author>Mickle, Don</author><author>Tong, Jeff</author></authors></contributors><titles><title>Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial</title><secondary-title>The Journal of thoracic and cardiovascular surgery</secondary-title></titles><periodical><full-title>The Journal of Thoracic and Cardiovascular Surgery</full-title></periodical><pages>755-764</pages><volume>112</volume><number>3</number><dates><year>1996</year></dates><isbn>0022-5223</isbn><urls></urls></record></Cite></EndNote>15. It has been reported that operation on the beating heart, have a lower postoperative complication therefore reduce the length of ICU stay ADDIN EN.CITE <EndNote><Cite><Author>Totonchi</Author><Year>2014</Year><RecNum>135</RecNum><DisplayText>4</DisplayText><record><rec-number>135</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>135</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Totonchi, Ziae</author><author>Baazm, Farah</author><author>Chitsazan, Mitra</author><author>Seifi, Somayeh</author><author>Chitsazan, Mandana</author></authors></contributors><titles><title>Predictors of prolonged mechanical ventilation after open heart surgery</title><secondary-title>Journal of cardiovascular and thoracic research</secondary-title></titles><periodical><full-title>Journal of cardiovascular and thoracic research</full-title></periodical><pages>211</pages><volume>6</volume><number>4</number><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>4.

The present patients profiles indicate that conventional CABG is using off-pump does not necessary require complicated and costly resources. A short length of ICU and hospital stay is often used as criteria for successful treatment. Lee et al have found that the economic consequences of complications after CABG are far more costly than uncomplicated recovery ADDIN EN.

CITE <EndNote><Cite><Author>Lee</Author><Year>1996</Year><RecNum>127</RecNum><DisplayText>29</DisplayText><record><rec-number>127</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>127</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Lee, Jai H</author><author>Kim, Kyung H</author><author>Murrell, Helen K</author><author>Cmolik, Brian L</author><author>Graber, Ray</author><author>Effron, Barry</author><author>Geha, Alexander S</author></authors></contributors><titles><title>Cost analysis of early extubation after coronary bypass surgery</title><secondary-title>Surgery</secondary-title></titles><periodical><full-title>Surgery</full-title></periodical><pages>611-619</pages><volume>120</volume><number>4</number><dates><year>1996</year></dates><isbn>0039-6060</isbn><urls></urls></record></Cite></EndNote>29. No studies in the medical literature have been evaluated the costs of FTE complications after CABG. In these environments, there are traditions to keep the patients in hospital to full fill both the demands for medical, social and emotional well-being. With the application of a common philosophy for all steps during and after operation, extubation within 12 hours was attainable and safe in the majority of the patients undergoing off pump CABG. In our study all of the surgery performed with off pump technique.

This method has a shorter surgery duration than cardiopulmonary bypass. In previous study it has been reported that prolonged duration of surgery and CPB increase the risk of delayedextubation ADDIN EN.CITE <EndNote><Cite><Author>Totonchi</Author><Year>2014</Year><RecNum>136</RecNum><DisplayText>4</DisplayText><record><rec-number>136</rec-number><foreign-keys><key app=”EN” db-id=”w2av9fwt50zvvee9t5b5s2fb9r5w5vzxzzde”>136</key></foreign-keys><ref-type name=”Journal Article”>17</ref-type><contributors><authors><author>Totonchi, Ziae</author><author>Baazm, Farah</author><author>Chitsazan, Mitra</author><author>Seifi, Somayeh</author><author>Chitsazan, Mandana</author></authors></contributors><titles><title>Predictors of prolonged mechanical ventilation after open heart surgery</title><secondary-title>Journal of cardiovascular and thoracic research</secondary-title></titles><periodical><full-title>Journal of cardiovascular and thoracic research</full-title></periodical><pages>211</pages><volume>6</volume><number>4</number><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>4. Retrospective design and small number of patients in a single center were limitations of our study.

However nonrandomized and small sample size as limitations of our study does not permit to conclude a decisive response, but the results of the present study indicated that age, gender, EF, diabetes, preoperative MI, hypertension, COPD, number of grafts, transfusion, IABP, stroke, hospital stay, inotrope use, post-operative apnea have a significant effect on prediction of extubation time. Our study also revealed that preoperative or intraoperative patient profiles and finding are of limited utility in predicting the likelihood of postoperative stroke. FTE after cardiac surgery enhances the cardiac function and reduces the length of ICU stay and causes an improvement in the intrapulmonary shunt fraction after extubation.

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