Early extubation after transthoracic oesophagectomy.

OBJECTIVES To assess patient outcome following transthoracic (Ivor-Lewis) oesophagectomy and the effects of epidural analgesia and early extubation compared with overnight sedation and ventilation. DESIGN Retrospective study. SETTING University teaching hospital, Hong Kong. SUBJECTS AND METHODS A retrospective review of patients undergoing oesophagectomy during two periods, 1990 to 1994 (n=65) and 1995 to 1998 (n=83), was completed. In the latter period, factors associated with early extubation were also evaluated. RESULTS Between 1990 and 1994, only three (4.6%) of 65 patients were extubated early compared with 34 (41.0%) of 83 patients between 1995 and 1998 (P<0.001). Comparing these two periods, there were no differences in respiratory complications or hospital mortality. In the period 1995 to 1998, more patients who were extubated early had received epidural analgesia (85% versus 41%, P<0.001). There were no differences between the early and late extubation groups in terms of respiratory complications and hospital mortality. Patients extubated early had shorter stays in the intensive care unit (1 versus 2 days, P=0.005). Epidural analgesia was an independent factor associated with early extubation (odds ratio=9.4; 95% confidence interval, 2.8-31.2). CONCLUSION After transthoracic oesophagectomy, early extubation is safe and can lead to a shorter stay in the intensive care unit. Epidural analgesia appears to facilitate early extubation.