The word ‘Opium’ is a Latin word

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 PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ub3RvbmNoaTwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ub3RvbmNoaTwvQXV0aG9yPjxZZWFyPjIwMTQ8L1llYXI+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==
ADDIN EN.CITE.DATA 4-6. Opium using has been known as a risk factor for CAD and respiratory track disease in several studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SYWhtYXRpPC9BdXRob3I+PFllYXI+MjAxNjwvWWVhcj48
UmVjTnVtPjEwOTwvUmVjTnVtPjxEaXNwbGF5VGV4dD5bNywgOF08L0Rpc3BsYXlUZXh0PjxyZWNv
cmQ+PHJlYy1udW1iZXI+MTA5PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVO
IiBkYi1pZD0idzJhdjlmd3Q1MHp2dmVlOXQ1YjVzMmZiOXI1dzV2enh6emRlIj4xMDk8L2tleT48
L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5
cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPlJhaG1hdGksIEF0aWVoPC9hdXRob3I+
PGF1dGhvcj5TaGFrZXJpLCBSYW1pbjwvYXV0aG9yPjxhdXRob3I+S2hhZGVtaSwgSG9vbWFuPC9h
dXRob3I+PGF1dGhvcj5Qb3V0c2NoaSwgSG9zc2VpbjwvYXV0aG9yPjxhdXRob3I+UG91cnNoYW1z
LCBBa3JhbTwvYXV0aG9yPjxhdXRob3I+RXRlbWFkaSwgQXJhc2g8L2F1dGhvcj48YXV0aG9yPkto
b3NobmlhLCBNYXNvdWQ8L2F1dGhvcj48YXV0aG9yPlNvaHJhYnBvdXIsIEFtaXIgQWxpPC9hdXRo
b3I+PGF1dGhvcj5BbGlhc2dhcmksIEFsaTwvYXV0aG9yPjxhdXRob3I+SmFmYXJpLCBFbGhhbTwv
YXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48dGl0bGVzPjx0aXRsZT5Nb3J0YWxpdHkg
ZnJvbSByZXNwaXJhdG9yeSBkaXNlYXNlcyBhc3NvY2lhdGVkIHdpdGggb3BpdW0gdXNlOiBhIHBv
cHVsYXRpb24tYmFzZWQgY29ob3J0IHN0dWR5PC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPlRob3Jh
eDwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPlRob3Jh
eDwvZnVsbC10aXRsZT48L3BlcmlvZGljYWw+PHBhZ2VzPnRob3JheGpubC0yMDE1LTIwODI1MTwv
cGFnZXM+PGRhdGVzPjx5ZWFyPjIwMTY8L3llYXI+PC9kYXRlcz48aXNibj4wMDQwLTYzNzY8L2lz
Ym4+PHVybHM+PC91cmxzPjwvcmVjb3JkPjwvQ2l0ZT48Q2l0ZT48QXV0aG9yPk5hamFmaXBvdXI8
L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxSZWNOdW0+MTEwPC9SZWNOdW0+PHJlY29yZD48cmVj
LW51bWJlcj4xMTA8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlk
PSJ3MmF2OWZ3dDUwenZ2ZWU5dDViNXMyZmI5cjV3NXZ6eHp6ZGUiPjExMDwva2V5PjwvZm9yZWln
bi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29u
dHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+TmFqYWZpcG91ciwgSGFtaWQ8L2F1dGhvcj48YXV0
aG9yPk1hc29vbWksIE1vaGFtbWFkPC9hdXRob3I+PGF1dGhvcj5TaGFoZXNtYWVpbGksIEFybWl0
YTwvYXV0aG9yPjxhdXRob3I+SGFnaGRvb3N0LCBBbGkgQWtiYXI8L2F1dGhvcj48YXV0aG9yPkFm
c2hhcmksIE1haGRpPC9hdXRob3I+PGF1dGhvcj5OYXNyaSwgSGFtaWQgUmV6YTwvYXV0aG9yPjxh
dXRob3I+S2Fobm9vamksIE1hc29vbWVoPC9hdXRob3I+PGF1dGhvcj5TYW1hZGksIFNhZHJhPC9h
dXRob3I+PGF1dGhvcj5NaXJ6YXphZGVoLCBBbGk8L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmli
dXRvcnM+PHRpdGxlcz48dGl0bGU+RWZmZWN0cyBvZiBvcGl1bSBjb25zdW1wdGlvbiBvbiBjb3Jv
bmFyeSBhcnRlcnkgZGlzZWFzZSByaXNrIGZhY3RvcnMgYW5kIG9yYWwgaGVhbHRoOiBSZXN1bHRz
IG9mIEtlcm1hbiBDb3JvbmFyeSBBcnRlcnkgRGlzZWFzZSBSaXNrIGZhY3RvcnMgU3R1ZHkgYSBw
b3B1bGF0aW9uLWJhc2VkIHN1cnZleSBvbiA1OTAwIHN1YmplY3RzIGFnZWQgMTUtNzUgeWVhcnM8
L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+SW50ZXJuYXRpb25hbCBqb3VybmFsIG9mIHByZXZlbnRp
dmUgbWVkaWNpbmU8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10
aXRsZT5JbnRlcm5hdGlvbmFsIGpvdXJuYWwgb2YgcHJldmVudGl2ZSBtZWRpY2luZTwvZnVsbC10
aXRsZT48L3BlcmlvZGljYWw+PHZvbHVtZT42PC92b2x1bWU+PGRhdGVzPjx5ZWFyPjIwMTU8L3ll
YXI+PC9kYXRlcz48dXJscz48L3VybHM+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT5=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SYWhtYXRpPC9BdXRob3I+PFllYXI+MjAxNjwvWWVhcj48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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 PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FbmdlbG1hbjwvQXV0aG9yPjxZZWFyPjE5OTQ8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5FbmdlbG1hbjwvQXV0aG9yPjxZZWFyPjE5OTQ8L1llYXI+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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.