Ultra-Fast Track Cardiac Anesthesia: Risks, Benefits, and Predictors of Outcome

Background: Ultra-fast track anesthesia (UFTA) aims at immediate extubation of cardiac surgical patients at the end of the operation. It has not been found to increase postoperative cardiorespiratory morbidity, sympathoadrenal stress, or mortality. On the other hand, it significantly reduces costs and improves resource utilization.Methods: Fifty two consecutive patients underwent open heart surgeries and were managed by the same anesthesiologist. All adult patients undergoing elective cardiac operations were included in the study. They were divided into 2 groups, 26 patients each, UFTA group and conventional group. Patients were given intravenous midazolam, before surgery as a premedication. Induction was achieved using midazolam, fentanyl, and propofol. Tracheal intubation was facilitated by atracurium. Maintenance of anesthesia was achieved using sevoflurane, and a continuous intravenous infusion of morphine. Postoperatively, patients received intravenous morphine infusion, intravenous morphine on demand, and intravenous paracetamol every 6 hours. Pain was assessed with Visual Analogue Scale (VAS), every 6 hours for the first 24 hours of their ICU stay.Results: There was a significant reduction in mean length of ICU stay between the UFTA and the conventional groups, 57.42 hours and 95.04 hours respectively. There was no significant difference in postoperative pain perception between the 2 groups. But there was a significant difference in ICU morphine usage between the 2 groups.Conclusion: The implementation of UFTA protocol led to a significant reduction in the length of ICU stay of adult patients undergoing elective cardiac surgical operations, without increasing postoperative complications.