Rapid sustained recovery after cardiac operations

Effect of a Dexmedetomidine Substitution During a Nationwide Propofol Shortage in Patients Undergoing Coronary Artery Bypass Graft Surgery

“…Fast-tracking patients who are to undergo coronary artery bypass graft (CABG) surgery has become a standard of practice. [1][2][3][4] Among the essential elements of this process are the choice and timing of appropriate anesthetics, standardization of the surgical approach, and using postoperative sedation and analgesia to provide patient comfort while allowing for early extubation. 5 Continued debate persists as to the ideal sedative to use when transitioning the patient from the operating room until extubation in the intensive care unit (ICU).…”

Redução do período de internação e de despesas no atendimento de portadores de cardiopatias congênitas submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida

“…Therefore, a mean reduction in costs by US$ 4,000 per patient (from US$ 27,761 to US$ 23,772) was observed during hospitalization 24 . The reductions in costs were as follows: 26% in surgeries for the correction of atrial septum; 28% in the surgical correction of ventricular septum; 29% in the correction of persistent ductus arteriosus; 26% in the correction of tetralogy of Fallot; and 16% in the correction of transposition of the great arteries 21 . This study also correlated costs with early extubation and shorter hospitalization, and also established a significant correlation with fewer days spent in the ICU 21 .…”

“…The reductions in costs were as follows: 26% in surgeries for the correction of atrial septum; 28% in the surgical correction of ventricular septum; 29% in the correction of persistent ductus arteriosus; 26% in the correction of tetralogy of Fallot; and 16% in the correction of transposition of the great arteries 21 . This study also correlated costs with early extubation and shorter hospitalization, and also established a significant correlation with fewer days spent in the ICU 21 . Another study 20 reported a decrease by US$ 1,004 and US$ 1,667 in patients with ischemic heart disease and valvular heart disease operated on, respectively.…”

“…The concept of fast-track cardiac surgery appeared in the beginning of the 1990s. The principles of the protocol adopted were as follows: 1) intense education in preoperative care, aiming at not delaying hospital discharge; 2) extubation as soon as possible; 3) administration of anti-inflammatory medications as required; 4) prophylactic medication for supraventricular arrhythmias and gastrointestinal complications; 5) the patient should become ambulatory as soon as possible; 6) careful administration of fluid volume; 7) hospital discharge expected to occur between the third and fifth postoperative days 10,21 . The articulated combination of these principles reduced the response to stress, to organic dysfunction, and the time for the complete recovery of the patient, resulting in a reduction in hospital costs.…”

Safety and Efficacy of Fast Track in Patients Undergoing Coronary Artery Bypass Surgery

“…It is a multidisciplinary approach to the care of the cardiac surgery patient, and incorporates modifications in anesthetic management, along with the technological advances that have occurred in myocardial protection and perfusion techniques, to facilitate safe early extubation. 6 The Oxford model of fast track recovery has been adopted by a number of Canadian cardiac surgical units. Fast track has been shown to effectively reduce costs with no apparent compromise to patient care.7 While a number of Canadian centers have a fast track cardiac surgery program, patients in these centers still go to an ICU facility.…”