Ultra fast-track anesthesia with operating room extubation in a patient undergoing OPCABG by combination of propofol-remifentanil-dexmedetomidine

A 56-year-old man with 3 coronary vessel disease (#5, HL, #13), underwent OPCABG. Anesthesia was induced with propofol (PRO), fentanyl and vecuronium, and maintained with continuous infusion of remifentanil (REM), PRO and vecuronium. After the revascularization of 3 vessels, we changed the infusion anesthetics from REM to dexmedetomidine (DEX), and 40 minutes later we extubated immediately after the operation in the operating room with no problems. Ultra fast-track anesthesia in off-pump coronary artery bypass grafting is controversial, largely because of a concern about increased risk of derangement in respiratory mechanics. But this method, general anesthesia by combination of propofol-remifentanil-dexmedetomidine without epidural analgesia, was very stable in the operative period, and respiration was well maintained after extubation in the operating room. There were no critical hypercapnea, hypoxia, ventilatory problems and any cardiac complications. This method provided suitable conditions for maintenance and emergence of anesthesia, and enabled a shorter stay in ICU of below 24 hours.