Fast-track method in cardiac surgery: evaluation of risks and benefits of continuous administration technique.
BACKGROUND
Fast-track is a method proposed to decrease medical costs through the reduction of patients' length of stay in the hospital. This study was carried out to assess the risks and benefits of conducting the fast-track method in cardiac anaesthesia and to evaluate the role of continuous infusion of short-acting anaesthetics in a successful fast-track protocol.


METHODS
100 cases were divided into two groups. In the fast-track group, fentanyl and propofol infusions were started at induction time and atracurium one hour later. No bolus drug was administered during the operation. Fentanyl infusion was continued up to 12 hours after surgery. The conventional extubation group received fentanyl and pancuronium as bolus doses. The two groups were evaluated for time of alertness and extubation in the intensive care unit, total analgesic dosage administered during the 24 hours after operation, arterial blood gas and peripheral saturation of oxygen before and after extubation.


RESULTS
Time period between intensive care unit admission and alertness was significantly different in the fast-track (1.3 hours) and control (3.3 hours) groups (p-value is less than 0.001) as well as total time of intubation in the intensive care unit (4.3 hours vs. 7 hours) (p-value is less than 0.001). No patient of the fast-track group experienced low pressure of arterial oxygen, low saturation of arterial oxygen, high pressure of arterial carbon dioxide or need for reintubation in the first 24 hours after surgery.


CONCLUSIONS
Continuous infusion of drugs in the fast-track method facilitates earlier extubation. It maintains continuous sedation and analgesia without increasing respiratory complications.
Najafi
M
M
Tehran Heart Center, Faculty of Medical Sciences, University of Tehran, North Kargar Avenue, Tehran 14117-13138, Iran. najafik@sina.tums.ac.ir
D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001279:Atracurium / Q000008:administration & dosage; D001026:Coronary Artery Bypass; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000145:classification*; D015742:Propofol / Q000008:administration & dosage*
D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D005283:Fentanyl; D015742:Propofol