Control of early postoperative pain is key to early extubation and mobilization. Patients who do not require postoperative ventilation can leave the ICU sooner and have much shorter lengths of stay (LOS).

Narcotics are effective but have many deleterious side effects (sedation, respiratory depression, constipation, nausea). Benzodiazepenes provide relief of anxiety, but little analgesia. Ketorolac (Toradol) is very effective and does not cause respiratory depression, but all NSAIDS including Toradol have the potential to cause acute renal insufficiency and is relatively contraindicated in diabetics for this reason, thus limiting its usefulness.

I have been impressed that post-CABG patients who are extubated on the operating table have significantly reduced hospital LOS.