Fast-track cardiac care for adult cardiac surgical patients

Abstract

Background Fast-track cardiac care is a complex intervention involving several components of care during cardiac anaesthesia and in the postoperative period, with the ultimate aim of early extubation a er surgery, to reduce length of stay in the intensive care unit and in the hospital. Safe and e ective fast-track cardiac care may reduce hospital costs. This is an update of a Cochrane review first published in 2003, updated in 2012 and updated now in 2016. Objectives To determine the safety and e ectiveness of fast-track cardiac care compared with conventional (not fast-track) care in adult patients undergoing cardiac surgery. Fast-track cardiac care intervention includes administration of low-dose opioid-based general anaesthesia or use of a time-directed extubation protocol, or both.

Early Extubation After Cardiac Surgery: A Better Predictor of Outcome than Metric of Quality?

“…2,4 According to the 2016 Cochrane review, fast-track cardiac care includes "administration of low-dose opioid-based general anesthesia or use of a time-directed extubation protocol, or both," with the goal of reducing ICU and hospital length of stay. 5 The fast-track concept has evolved even further in some cases to direct postoperative treatment in a postanesthesia care unit with the primary goal of early extubation, followed by transfer to a stepdown unit, bypassing the ICU entirely. 3,6 Although no standard definition exists for fast-track extubation, extubation within 6 hours after surgery has been popular in the literature.…”

“…Notably, overall hospital length of stay was unchanged with the intervention, as was seen with the most recent Cochrane meta-analysis of fast track protocols after elective cardiac surgery. 5 With no significant change in hospital length of stay, there does not seem to be an appreciable harm from this protocol, but one must question the appropriateness of obsessing over extubation by the 6-hour mark.…”

Association of earlier extubation and postoperative delirium after coronary artery bypass grafting

“…11,12 Anesthesia techniques that use lower doses of opioids and reversal of neuromuscular blockade have facilitated early extubation after cardiac surgery with shorter intensive care unit (ICU) LOS and are now widely accepted. 13,14 There is evidence to suggest that extubation within the operating room (OR) itself may additionally reduce hospital LOS and costs without increasing major adverse event (MAE) rates or the need for reintubation. 15,16 Although there is an established association between prolonged mechanical ventilation and delirium, the nature of this association in the cardiac surgery patient is uncertain.…”

Recovery after laparoscopic anesthesia: Three different anaesthesia techniques: Recovery after laparoscopic anesthesia

“…Važno je da se preduzmu adekvatne mere bezbednosti kako se ovi efekti ne bi ispoljili, a to pre svega podrazumeva boravak pacijenta u sobi za oporavak nakon operacije i anestezije. Skraćenje ovog perioda značajno snižava troškove hirurške procedure, ali i celokupnog bolesnikovog lečenja 14 . Naša studija je pokazala da je u LFGF SS grupi period P5 bio najkraći, a da je u VIMA grupi bio statistički značajno duži nego u druge dve grupe.…”