Advances in cardiac anesthesia techniques and intensive care

Cardiac services are the biggest consumer of healthcare resources. Populati on statistics suggest that the aging population will need more cardiac care . This need will likely intensify the fiscal pressures on cardiac care prov iders. The emphasis is clearly on doing more with less, that is, minimizing the invasiveness of diagnostic, therapeutic, and monitoring procedures and accomplishing shorter hospital stay. Cardiac anesthesia and cardiac ICUs a re under the same pressure. Analogous to other areas in cardiac care, cardi ac anesthesia and intensive care medicine has experienced an explosion in t echnology, techniques, and pharmacotherapeutics. Just as minimally invasive cardiac surgery is challenging conventional cardiac surgery and catheter-b ased techniques, value-based goal-oriented cardiac anesthesia and new analg esic techniques are producing a paradigm shift from conventional high-dose narcotic anesthesia and prolonging postoperative ventilation. Unfortunately , our desire to introduce new technology has skipped ahead of the need to r igorously evaluate these techniques using simple clinical rules of evidence based medicine. The challenge for cardiac anesthesia and cardiac ICUs in t he new millennium will be to adopt cost-effective technologies and strategi es focused on patient care and to discard the often hyped and intensely fas hionable but expensive technology. This article reviews the advances in car diac surgery, cardiac anesthesia techniques, and the fast-track cardiac rec overy models.