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Fast track extubation in cardiac surgery

Joshua A Heller, Rishi Kothari, Hung-Mo Lin, Matthew A Levin, Menachem Weiner
OBJECTIVE: Determine if surgery start time impacts patient outcomes in elective cardiac surgery. DESIGN: This was a retrospective study. SETTING: This study was based at a single academic institution. PARTICIPANTS: Patients undergoing elective cardiac surgery over a 3-year period were included. INTERVENTIONS: There were no interventions. MEASUREMENTS AND MAIN RESULTS: The authors performed a retrospective study of patients undergoing elective cardiac surgery over a 3-year period...
August 17, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Rashad Zayat, Ares K Menon, Andreas Goetzenich, Gereon Schaelte, Ruediger Autschbach, Christian Stoppe, Tim-Philipp Simon, Lachmandath Tewarie, Ajay Moza
BACKGROUND: The use of left ventricular assist devices (LVADs) has gained significant importance for treatment of end-stage heart failure. Fast-track procedures are well established in cardiac surgery, whereas knowledge of their benefits after LVAD implantation is sparse. We hypothesized that ultra-fast-track anesthesia (UFTA) with in-theater extubation or at a maximum of 4 h. after surgery is feasible in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 3 and 4 patients and might prevent postoperative complications...
February 8, 2017: Journal of Cardiothoracic Surgery
Christian GRAß, Federica Stretti, Waseem Zakhary, Edwin Turton, Sophia Sgouoropoulou, Meinhard Mende, Jörg Ender
BACKGROUND: Fast-track (FT) treatment in cardiac anesthesia is a state-of-the-art technique. The aim of our study was to compare FT treatment in a post-anesthetic care unit (PACU) with limited opening hours with a PACU opened for unlimited hours. Primary endpoints were extubation time (ET), length of stay (LOS) in PACU and LOS in intermediate care unit (IMC). Secondary endpoints were FT success/failure, hospital LOS, re-intubation and in hospital mortality. METHODS: At our institution, FT is usually managed in a PACU with limited opening hours from 10 a...
February 2017: Minerva Anestesiologica
Wai-Tat Wong, Veronica Kw Lai, Yee Eot Chee, Anna Lee
BACKGROUND: Fast-track cardiac care is a complex intervention involving several components of care during cardiac anaesthesia and in the postoperative period, with the ultimate aim of early extubation after surgery, to reduce length of stay in the intensive care unit and in the hospital. Safe and effective fast-track cardiac care may reduce hospital costs. This is an update of a Cochrane review first published in 2003, updated in 2012 and updated now in 2016. OBJECTIVES: To determine the safety and effectiveness of fast-track cardiac care compared with conventional (not fast-track) care in adult patients undergoing cardiac surgery...
September 12, 2016: Cochrane Database of Systematic Reviews
Jigar Patel, Rajesh Thosani, Jignesh Kothari, Pankaj Garg, Himani Pandya
BACKGROUND: The current era of fast-track extubation and faster recovery after cardiac surgery requires agents that provide perioperative sedation, suppress sympathetic response, reduce opioid requirement, and maintain hemodynamic stability. METHODS: In a prospective randomized double-blind study, 75 off-pump coronary artery bypass patients were divided into 3 groups of 25 each: group A had clonidine 1 µg·kg(-1), group B had clonidine 1 µg·kg(-1) and ketamine 1 mg·kg(-1), and group C had a saline placebo...
September 2016: Asian Cardiovascular & Thoracic Annals
Paulo Sérgio da Silva, Márcio Portugal Trindade Cartacho, Casimiro Cardoso de Castro, Marcello Fonseca Salgado Filho, Antônio Carlos Aguiar Brandão
OBJECTIVE: To evaluate the influence of pulmonary hypertension in the ultra-fast-track anesthesia technique in adult cardiac surgery. METHODS: A retrospective study. They were included 40 patients divided into two groups: GI (without pulmonary hypertension) and GII (with pulmonary hypertension). Based on data obtained by transthoracic echocardiography. We considered as the absence of pulmonary hypertension: a pulmonary artery systolic pressure (sPAP) <36 mmHg, with tricuspid regurgitation velocity <2...
July 2015: Revista Brasileira de Cirurgia Cardiovascular
Hee Young Kim, Seung-Hoon Baek, Hyung Gon Je, Tae Kyun Kim, Hye Jin Kim, Ji Hye Ahn, Soon Ji Park
BACKGROUND: Minimally invasive cardiac surgery (MICS) has been more commonly performed due to the reduced amount of bleeding and transfusion and length of hospital stay. We investigated the feasibility of performing MICS using single-lumen endotracheal tube (SLT). METHODS: We conducted a retrospective review of clinical data of 112 patients who underwent MICS between July 2012 and March 2015. The patients underwent MICS using a SLT or a double lumen endotracheal tube (DLT)...
May 2016: Journal of Thoracic Disease
Maxim Roy, Nathalie Morissette, Martin Girard, Nicholas Robillard, Pierre Beaulieu
PURPOSE: We report a case of awake paralysis due to residual neuromuscular blockade (NMB) in the intensive care unit (ICU) in a patient following fast-track cardiac surgery. As a result of this case, we performed a prospective quality assurance audit to investigate the incidence of residual paralysis in the ICU in a similar population of cardiac surgery patients. CLINICAL FEATURES AND AUDIT METHODS: A 73-yr-old woman (69 kg) underwent coronary artery bypass surgery under anesthesia induced with intravenous sufentanil 25 µg, midazolam 5 mg, ketamine 25 mg, and rocuronium 100 mg (followed by two additional 50-mg doses during surgery) and maintained with sevoflurane...
June 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Stephen Aniskevich, Sher-Lu Pai
Historically, patients undergoing liver transplantation were left intubated and extubated in the intensive care unit (ICU) after a period of recovery. Proponents of this practice argued that these patients were critically ill and need time to be properly optimized from a physiological and pain standpoint prior to extubation. Recently, there has been a growing movement toward early extubation in transplant centers worldwide. Initially fueled by research into early extubation following cardiac surgery, extubation in the operating room or soon after arrival to the ICU, has been shown to be safe with proper patient selection...
September 18, 2015: World Journal of Hepatology
Amir Abbas Kianfar, Zargham Hossein Ahmadi, Seyed Mohsen Mirhossein, Hamidreza Jamaati, Babak Sharif Kashani, Seyed Amir Mohajerani, Ehsan Firoozi, Farshid Salehi, Golnar Radmand, Seyed Mohammadreza Hashemian
BACKGROUND: Heart transplant surgeries using cardiopulmonary bypass (CPB) typically requires mechanical ventilation in intensive care units (ICU) in post-operation period. Ultra fast-track extubation (UFE) have been described in patients undergoing various cardiac surgeries. AIM: To determine the possibility of ultra-fast-track extubation instead of late extubation in post heart transplant patients. MATERIALS AND METHODS: Patients randomly assigned into two groups; Ultra fast-track extubation (UFE) group was defined by extubation inside operating room right after surgery...
April 2015: International Journal of Critical Illness and Injury Science
Daniel Bainbridge, Davy C Cheng
Off-pump surgery was the original approach to treating patients with cardiac disease in the era before cardiopulmonary bypass. With the advent and refinement of cardiopulmonary bypass, the use of this technique fell out of favor and was quickly surpassed by on-pump techniques. However, the limitations of bypass surgery, especially for coronary artery bypass procedures, was still significant, leading to renewed interest in this technique. Postoperative care for off-pump coronary artery bypass (OPCAB) surgery presents both a challenge and opportunity to the intensivist...
June 2015: Seminars in Cardiothoracic and Vascular Anesthesia
Ahmed Said Elgebaly, Ahmed Ali Eldabaa
BACKGROUND: Anesthetists used lower doses of fentanyl, successfully with hemodynamic control by titrating volatile anesthetic agents or vasodilators for fast-tracking in cardiac surgery. HYPOTHESIS: Lower total doses of anesthetics and fentanyl could be required with hemodynamic control by use of supraglottic devices than endotracheal tube (ETT) and helps in fast-tracking. DESIGN: A prospective randomized observational clinical trial study...
May 2014: Anesthesia, Essays and Researches
Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai, Naveed Rehman
Fast-track extubation is an established safe practice in pediatric congenital heart disease (CHD) surgical patients. On table extubation (OTE) in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF) cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post-TOF repair complications such as low cardiac output state and arrhythmias...
April 2015: Annals of Cardiac Anaesthesia
Aristotelis Panos, Sylvio Vlad, Fotios Milas, Patrick O Myers
OBJECTIVES: Traditional resectional techniques and chordal transfer are difficult to apply in video-assisted mitral valve repair. Using artificial chords appears easier in this setting. The purpose of this study was to review the effectiveness and reproducibility of neochordal repair as a routine approach to minimally invasive mitral repair, and to assess the stability of neochord implantation using the figure-of-eight suture without pledgets in this setting. METHODS: This is a retrospective review of all patients who underwent minimally invasive video-assisted mitral valve repair from 2008 to 2013...
June 2015: Interactive Cardiovascular and Thoracic Surgery
Yucel Karaman, Burcin Abud, Zeki Tuncel Tekgul, Meltem Cakmak, Murside Yildiz, Mustafa Gonullu
PURPOSE: We aim to compare the effects of propofol and dexmedetomidine infusions on extubation times, hemodynamic and respiratory functions, complication rates and patient satisfaction scores in patients undergoing coronary artery bypass graft (CABG) surgery using a fast-track anesthesia regimen for early extubation. METHODS: We enrolled 64 patients who underwent CABG surgery. Dexmedetomidine (min 0.2 µg/kg/h-max 1.0 µg/kg/h) and propofol (min 1.0 mg/kg/h-max 3...
August 2015: Journal of Anesthesia
Lisa M Soltis
Health care reform continues to focus on improving patient outcomes while reducing costs. Clinical nurse specialists (CNSs) should facilitate this process to ensure that best practice standards are used and patient safety is enhanced. One example of ensuring best practices and patient safety is early extubation after open heart surgery, which is a critical component of fast track protocols that reduces may reduce the development of pulmonary complications in the postoperative period while decreasing overall length of stay in the hospital...
January 2015: AACN Advanced Critical Care
Jennifer L Vance, Amy M Shanks, Derek T Woodrum
BACKGROUND: Fast track recovery is a care process goal after cardiac surgery. Intraoperative anesthetic depth may impact recovery, but the impact of brain monitoring on time to extubation and intensive care unit (ICU) length of stay after cardiac surgery has not been extensively studied. Our goal was to determine if BIS-guided anesthesia improves time to extubation compared to MAC-guided anesthesia in a cardiac surgery population. METHODS: In this secondary outcome analysis of a randomized controlled study, we analyzed 294 patients undergoing elective coronary bypass grafting, valve replacements, and bypass plus valve replacements at a single tertiary referral center between February 1, 2009 and April 30, 2010...
2014: BMC Anesthesiology
Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai, Amina Rehmat Wali, Anwar-Ul-Haq, Muneer Aman-Ullah, Khalid Ahsan
BACKGROUND AND AIMS: Early extubation after cardiac operations is an important aspect of fast-track cardiac anesthesia. In order to reduce or eliminate the adverse effects of prolonged ventilation in pediatric congenital heart disease (CHD) surgical patients, the concept of early extubation has been analyzed at our tertiary care hospital. The current study was carried out to record the data to validate the importance and safety of fast-track extubation (FTE) with evidence. MATERIALS AND METHODS: A total of 71 patients, including male and female aged 6 months to 18 years belonging to risk adjustment for congenital heart surgery-1 category 1, 2, and 3 were included in this study...
July 2014: Journal of Anaesthesiology, Clinical Pharmacology
Stefan Probst, Christof Cech, Dirk Haentschel, Markus Scholz, Joerg Ender
INTRODUCTION: Fast-track treatment in cardiac surgery has become the global standard of care. We compared the efficacy and safety of a specialised post-anaesthetic care unit (PACU) to a conventional intensive care unit (ICU) in achieving defined fast-track end-points in adult patients after elective cardiac surgery. METHODS: In a prospective, single blinded, randomized study, 200 adult patients undergoing elective cardiac surgery (coronary artery bypass graft (CABG), valve surgery or combined CABG and valve surgery), were selected to receive their postoperative treatment either in the ICU (n = 100), or in the PACU (n = 100)...
August 15, 2014: Critical Care: the Official Journal of the Critical Care Forum
Matthew Wanat, Kalliopi Fitousis, Fariedeh Boston, Faisal Masud
Many cardiovascular surgeries are fast-tracked to extubation and require short-term sedation. Dexmedetomidine and propofol have very different mechanisms of action and pharmacokinetic profiles that make them attractive sedative agents in this patient population. Recently, there has been increased use of dexmedetomidine in the intensive care unit (ICU), but few studies exist or have been published directly comparing both agents in this setting. We conducted a retrospective cohort study with patients admitted to the ICU after cardiovascular surgery from January through June 2011...
April 2014: Methodist DeBakey Cardiovascular Journal
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