Ultra-fast-track anesthetic technique facilitates operating room extubation in patients undergoing off-pump coronary revascularization surgery

Objective: To determine if implementation of ultra-fast-track anesthetic (U FTA) technique facilitates operating room extubation in patients undergoing off-pump coronary artery bypass graft (CABG) surgery. Design: Retrospective review. Setting: Referral center for cardiovascular surgery at a university hospita l. Participants: Thirty-seven patients undergoing off-pump CABG surgery. Interventions: Two groups represented UFTA (n = 10) and standard anesthetic (controls, n = 27) techniques. Anesthesia was conducted with propofol, rem ifentanil, vecuronium, and thoracic epidural analgesia in the UFTA group an d thiopental, fentanyl, pancuronium, and isoflurane in the control group. A ctive temperature control was an integral part of the UFTA technique but no t the standard technique. The active temperature control included intraveno us fluid warmer, prewarmed skin preparation, humidified inspired gases, a c irculating water warming blanket, and a forced-air warmer, along with the m aintenance of the operating room temperature at 24 degreesC. The control gr oup was managed with an intravenous fluid warmer, and the ambient temperatu re remained constant (20 degreesC). Patients who did not satisfy extubation criteria within 30 minutes from the end of surgery were sedated and transf erred to the intensive care unit (ICU). Measurements and Main Results: All patients in the UFTA group and 2 in the control group were extubated in the operating room immediately after surger y. None of the patients required reintubation. There was no significant dif ference in postextubation PaO2 and PaCO2 between the groups. Nasopharyngeal temperature decreased from 36.7 +/- 0.4 degreesC to 36.4 +/- 0.3 degreesC in the UFTA group and from 36.6 +/- 0.5 degreesC to 35.6 +/- 0.4 degreesC i n the control group (p < 0.0001). Bradycardia occurred significantly more o ften in the UFTA group but there was no difference in episodes of hypotensi on. There were no perioperative deaths. Patients who were extubated in the operating room required lower nurse-to-patient acuity ratio (1:2) in the IC U. No difference was found in ICU and hospital length of stay. Conclusions: Implementation of UFTA technique provided adequate hemodynamic control and facilitated operating room extubation in all patients. The imp act of UFTA on earlier patient discharge and actual cost savings within a f ully integrated post-cardiac surgery unit requires further evaluation. Copy right (C) 2001 by W.B. Saunders Company.