title: Fast tracking in adult cardiac surgery at Pakistan Institute of Medical Sciences.
abstract: BACKGROUND
  Early extubation after cardiac operation is an important aspect of fast-track cardiac anaesthesia. The length of stay in ICU limits utilisation of operation theatre in cardiac surgery. Increasing cost, limited resources, and newer surgical strategies have stimulated effectiveness of all routines in cardiac surgery, anaesthesia, and intensive care. Aim of this study was to determine the feasibility of fast-tracking in adult cardiac surgery and its effects on post operative recovery in our setup.
  
  
  METHODS
  This descriptive study was conducted over 14 months between 16th Jul 2007 to 16th Sep 2008. All the open heart cases were included unless absolute contraindications were there. We applied the rapid recovery protocol adopted from Oslo Hospital Norway in an attempt to achieve fast-tracking in our setup.
  
  
  RESULTS
  Two-hundred-seventy-four consecutive cases out of 400 operated cases were included in this study. Mean age was 47.69 +/- 15.11 years, 27.7% were females, 5.8% were emergency cases. 5.1% were COPD, 11.1% were atrial fibrillation, and 6.9% were NYHA class-III cases. CABG was done in 66.1% cases and mean CPB-time was 75.92 +/- 16.20 min. Mean Ventilation-time was 4.47 +/- 4.48 hrs, 86% patients were fast-tracked to be extubated within 6 hours, and 85.4% patients remained free of post-op complications. Six (2.2%) re-intubatlions, 2.6% arrhythmias, 6.6% pleural effusions and 2.2% consolidation were observed post-operatively. Mean ICU stay was 2.49 +/- 0.95 days and in-hospital mortality was 2.2%.
  
  
  CONCLUSIONS
  Fast-tracking with extubation within 6 hours is feasible approach which minimises the post-operative complications significantly in adult cardiac surgical patients.
authors.affiliation: Department of Cardiac Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. naved.dr@gmail.com
authors.forename: Naveed
authors.initials: N
authors.lastname: Ahmed
authors.forename: Faridullah
authors.initials: F
authors.lastname: Khan
authors.forename: Mahrukh
authors.initials: M
authors.lastname: Zahoor
authors.lastname: Badar-ur-Samad
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rafique
authors.forename: Muhammad
authors.initials: M
authors.lastname: Faisal
authors.forename: Rana Imran
authors.initials: RI
authors.lastname: Sikander
mesh_terms: D000328:Adult; D060666:Airway Extubation / Q000706:statistics & numerical data*; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013997:Time Factors