Dr Bharathi Varadarajan, Topic Advisor, NHS Evidence - surgery, anaesthesia, perioperative and critical care and Consultant cardiac anaesthetist, Royal Victoria Hospitals, Belfast Health and Social Care Trust, Belfast
Introduction
Fast track cardiac surgery (FTCS) has been practised since 1974. In FTCS the perioperative care pathway swiftly progresses from admission through surgery to discharge home whilst at all times promoting the health and safety of the patient. Early discontinuation of respiratory support and sedation, coupled with return to the awake state and normal breathing after FTCS is crucial. The combination of optimal anaesthetic technique (amnesia, analgesia and haemodynamic stability), adequate myocardial protection, short cardiopulmonary bypass (CPB) time and safe surgical procedure allows almost all groups of patients to be extubated safely. In FTCS, patients are woken up after cardiac surgery as soon as near-normothermia, normal pulmonary function and haemodynamic stability are achieved in the absence of any surgical or coagulopathic bleeding. This results in stepping down of nursing care from intensive (Level 3) to high dependency (Level 2) care. At the time of extubation, patients should be comfortable, pain-free and have good muscle power without shivering and agitation. Among other benefits, this enables them to establish oral feeding and early ambulation. Mortality and length of both intensive care and hospital stay are reduced in FTCS patients when compared to conventional cardiac surgical practice where in-patients are kept sedated and ventilated overnight following a high opioid-based anaesthetic technique.
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