Fast-Track Cardiac Anesthesia
Fast-track, or early, extubation following cardiac surgery is
variously defined, but most agree that extubation within 8 hours qualifies as such.
The impetus for fast-track anesthesia is primarily economic. Studies in this area
are also motivated by the desire to improve safety. Several such studies have been
performed, some prospective and randomized and some prospective with retrospective
cohort controls. Importantly, Cheng and colleagues' prospective randomized study
[186]
demonstrated no increase in
postoperative myocardial ischemia in indices of the stress response, or respiratory
morbidity or mortality after fast-track cardiac anesthesia. Other studies[187]
[188]
[189]
found
similar results regarding the absence of an increase in mortality. Fast-track cardiac
anesthesia does not necessarily realize the economic benefits often attributed to
it unless one has the capacity to decrease intensive care unit (ICU) stay or other
aspects of care after extubation. As implied in the discussion of specific anesthetics,
fast-track cardiac anesthesia dictates the use of low-dose narcotics (fentanyl, 10
to 15 µg/kg or its equivalent), a volatile anesthetic, and propofol infusions
during and after CPB. Postsurgical rectal indomethacin administration is a frequently
used analgesic technique.
