Fast track as a routine for open heart surgery.
OBJECTIVE
Evaluation of thoracic epidural analgesia (TEA), normothermic cardiopulmonary bypass (CPB) and normothermic blood cardioplegia as a routine procedure for fast track open heart surgery.


METHODS
Consecutive patients (n=250, age 36--81 years, mean 63, M/F, ratio=4) were subjected to the combination of general anaesthesia using ultra-short acting opiates, TEA, normothermic CBP, normothermic whole blood cardioplegia. Operative procedures included coronary artery bypass grafting (CABG), valve replacement, combined CABG and valves, aortic aneurysm and Maze III. LVEF ranged 20--76%. Eighty percent were in Tuman score 0--5 and 20% in score >5.


RESULTS
All patients were extubated within 10 min after skin closure. There was one myocardial infarction. Four percent were shortly treated with cathecholamines. Postoperative atrial fibrillation was noticed in 9.6%. Four transient cerebral ischemic events were encountered. No neurological disturbance related to the use of TEA was seen. Seven patients were reoperated because of bleeding. Blood transfusion was given to 6.4% of the patients. Mortality was 0.8%.


CONCLUSIONS
The combined methods provides a way for routine immediate postoperative extubation, with low morbidity and short hospital stay.
Oxelbark
S
S
Heart Center Varde, 6800 Varde, Denmark. sten@bypass.dk
Bengtsson
L
L
Eggersen
M
M
Kopp
J
J
Pedersen
J
J
Sanchez
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D006324:Heart Arrest, Induced; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D013997:Time Factors