Fast-track cardiac anaesthesia in the elderly: effect of two different anaesthetic techniques on mental recovery

Elderly patients may be considered for 'fast-track' cardiac anaesthesia, bu t can suffer psychological complications and slow recovery of mental functi on after surgery, which can interfere with recovery. Reduced metabolism and changed distribution of anaesthetic and sedative agents can cause poor rec overy. We made a prospective randomized comparison of mental function, haem odynamic stability and extubation and discharge times in elderly patients ( 65-79 yr) receiving two premedication, anaesthetic and sedative techniques. Patients received either propofol (n=39) (fentanyl 10-15 mug kg(-1) and pr opofol 2-6 mg kg(-1) intraoperatively and a propofol infusion for 3 h posto peratively) or premedication with lorazepam followed by midazolam for anaes thesia (n=39) (fentanyl 10-15 mug kg(-1) and midazolam 0.05-0.075 mg kg(-1) intraoperatively and a midazolam infusion for 3 h postoperatively). Impair ment of mental function was noted in 41% of patients in the propofol group and 83% in the lorazepam and midazolam group (P=0.001) 18 h after extubatio n. Patients in the propofol group were extubated earlier [1.4 (SD 0.6) vs 1 .9 (0.8) h, P=0.02]; and reached standard intensive care unit discharge cri teria [7.6 (4.6) vs 14.2 (13) h, P=0.02] and hospital discharge criteria [4 .3 (1.0) vs 4.9 (1.1) days, P=0.04) sooner than patients in the lorazepam a nd midazolam group, bur actual discharge times did not differ between the g roups. Haemodynamic values were stable in both groups.