The incidence of intraoperative awareness in cardiac surgery fast-track treatment.
OBJECTIVE
To determine the occurrence of intraoperative awareness with recall in cardiac surgery patients undergoing fast-track anesthetic management in a direct-admission postanesthetic care unit.


METHODS
Prospective.


METHODS
University-affiliated heart center.


METHODS
Five hundred thirty-four patients undergoing fast-track anesthesia.


METHODS
Using a structured interview process as part of the quality-assurance program.


RESULTS
All fast-track patients during an 8-month period were entered into the study at a university hospital. Each patient was interviewed by research staff with the same standard set of questions within the first 24 hours of surgery. Follow-up interviews were performed on day 3 or 4 as well as on day 6 or 7 postsurgery. Awareness was defined by the presence of explicit memory of any event from the induction of anesthesia to the recovery of consciousness in the postanesthetic care unit (PACU). A final study population of 514 patients was evaluated. None of the answers given by any patient during any of the 3 interviews indicated intraoperative awareness, with the exception of one 54-year-old male patient. Most likely, this potential awareness did not take place during the operation but was caused by inadequate awakening in the PACU.


CONCLUSIONS
Therefore, the authors conclude that, with respect to intraoperative awareness, the "Leipzig Fast-Track Concept" with the use of ultra-short-acting opioids should be considered as a safe method of management of patients undergoing a wide variety of cardiac operations.
Groesdonk
Heinrich V
HV
Department of Anesthesiology and Intensive Care II, Leipzig Heart Center, University of Leipzig, Leipzig, Germany. medicine@groesdonk.net
Pietzner
Janine
J
Borger
Michael A
MA
Fassl
Jens
J
Haentschel
Dirk
D
Paarmann
Hauke
H
Ender
Joerg
J
D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D058926:Intraoperative Awareness / Q000453:epidemiology* / Q000209:etiology*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome