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 cardiacanaesthesia. The length of stay in ICU limits utilisation of operation theatre in cardiac surgery. Increasingcost, limited resources, and newer surgical strategies have stimulated effectiveness of all routines incardiac surgery, anaesthesia, and intensive care. Aim of this study was to determine the feasibility offast-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 theopen heart cases were included unless absolute contraindications were there. We applied the rapidrecovery protocol adopted from Oslo Hospital Norway in an attempt to achieve fast-tracking in oursetup. Results: Two-hundred-seventy-four consecutive cases out of 400 operated cases were included inthis 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 in66.1% 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-opcomplications. Six (2.2%) re-intubatIions, 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-hospitalmortality was 2.2%. Conclusion: Fast-tracking with extubation within 6 hours is feasible approachwhich minimises the post-operative complications significantly in adult cardiac surgical patients.Keywords: Fast-tracking, Adult cardiac surgery, early extubationReferences
Meade M, Guyatt G, Butler R, Elms B, Hand L, Ingram A, et
al. Trials Comparing Early vs Late Extubation Following
Cardiovascular Surgery. Chest 2001;120:445–53.
Cheng DCH, Karski J, Peniston C, Asokumar B, Raveendran
G, Carroll J, et al. Morbidity Outcome In Early Versus
Conventional Tracheal Extubation After Coronary Artery
Bypass Grafting: A Prospective Randomized Controlled Trial.
J Thorac Cardiovasc Surg 1996;112:755–64.
Royse CF, Royse AG, Soeding PF. Routine Immediate
00 10.00 20.00 30.00 40.00
Ventilation time
00
00
00
00
00
00
emiTBPC
Post op
complications
none
Reintubation
Pulmonary oedema
Arrythmias
Pleural effusions
Lung /segmental
collapse
J Ayub Med Coll Abbottabad 2010;22(3)
http://www.ayubmed.edu.pk/JAMC/PAST/22-3/Naveed.pdf 31
Extubation After Cardiac Operation: A Review of Our First
Patients. Ann Thorac Surg 1999;68:1326–9.
Muralidhar K, Banakal S, Murthy K, Gurg R, Rani GR,
Dinesh R. Bispectral Index-guided Anaesthesia for Off-pump
Coronary Artery Bypass Grafting. Annals of cardiac
anaesthesia 2008;11:105–10.
Gooi J, Marasco S, Rowland M, Esmore D, Negri J, Pick A.
Fast track Cardiac surgery: Application in an Australian
setting. Asian cardiovasc thorac Ann 2007;15:139–43
Konstantakos AK, Lee HJ. Optimizing Timing of Early
Extubation in Coronary Artery Bypass Surgery Patients. Ann
Thorac Surg 2000;69:1842–5
Ranucci M, Bellucci C, Conti D, Cazzaniga A, Maugeri B.
Determinants of Early Discharge from the Intensive Care Unit
after Cardiac Operations. Ann Thorac Surg 2007;83:1089–95.
Øvrum E, Tangen G, Schiøtt C, Dragsund S. Rapid recovery
protocol applied to 5,658 consecutive “on-pump” coronary
bypass patients. Ann Thorac Surg 2000;70:2008–12.
Kogan A, Ghosh P, Preisman S, Tager S, Sternik L, Lavee J et
al. Risk factors for failed “Fast-Tracking” after cardiac
surgery in patients older than 70 years. J Cardiothorac Vasc
Anesth 2008;22:530–5.
Walthall H, Robson D, Ray S. Do any preoperative variables
affect extubation time after coronary artery bypass graft
surgery? J Acute Critical care, Heart Lung 2001;30:216–24.
Capdeville M, Lee JH, Taylor AL. Effect of gender on
fast-track recovery after coronary artery bypass graft surgery.
J Cardiothorac Vasc Anesth 2001;15:146–51
Vida VL, Leon-Wyss J, Rojas M, Mack R, Barnoya J,
Castañeda AR. Pulmonary Artery Hypertension: Is It Really a
Contraindicating Factor for Early Extubation in Children
After Cardiac Surgery? Ann Thorac Surg 2006;81:1460–5.
Lena P, Balarac N, Lena D, Chapelle ADL, Arnulf
J, Mihoubi A. Fast-track anesthesia with remifentanil and
spinal analgesia for cardiac surgery: The effect on pain control
and quality of recovery. J Cardiothorac Vasc Aneasth
;22:536–42.
Meade M, Guyatt G, Cook D, Griffith L, Sinuff T, Kergl C et
al. Predicting success in weaning from mechanical ventilation.
Chest 2001;120:400S–24S.
Vanek T, Brucek P, Straka Z. Fast track as a routine for open
heart surgery. Eur Cardio Vasc Surg 2002;21:369.
Lazar HL, Fitzgerald C, Gross S, Heeren T, Aldea G, Shemin
R. Determinants of length of stay after CABG surgery.
Circulation 1995;92:20–4.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
