Anest. intenziv. Med. 2007;18(5):276-281
Fast-track and ultra fast-track cardiac anaesthesia - postoperative pain and other parameters observationAnaesthesiology - Original Paper
- 1 Kardiochirurgická klinika 3. LF UK a FNKV, Praha
- 2 Katedra pravděpodobnosti a matematické statistiky MFF UK, Praha
Objective:
We have been using fast-track techniques (alfentanil and remifentanil based) for cardiac anaesthesia in our department routinely since 2001. The aim of this study was to compare these two methods.
Design:
A prospective follow-up study.
Setting:
Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Charles University, Prague.
Materials and methods:
In the prospective follow-up study, 71 consecutive patients (alfentanil 32, remifentanil 39) undergoing common cardiothoracic procedures were observed during 2006. The following parameters were observed: time to extubation, length of ICU stay, length of stay on ward, incidence of postoperative atrial fibrillation, blood gases, postoperative pain grade (assessed 1 hour after extubation and on 1st post - operative day on the visual analogue pain scale and the SF McGill questionnaire), analgesic requirements.
Results:
There were no statistically significant differences in the most of observed parameters. Postoperative pain was dependent solely on patient's age (p < 0.001) and gender (p = 0.042).
Conclusion:
Both methods allow early and safe extubation of patients undergoing cardiothoracic surgery.
Keywords: cardiac anaesthesia; fast-track; alfentanil; remifentanil; pain
Published: October 1, 2007 Show citation
References
- Shapiro, B. A., Lichtenthal, P. R. Inhalation based anestetic techniques are the key to early extubation of the cardiac surgical patient. J. Cardiothorac. Vasc. Anesth., 1999, 7, p. 135-136.
Go to original source...
Go to PubMed...
- London, M. J., Shroyer, L. W., Jernigan, V. et al. Fast-track Cardiac Surgery in a Departement of Veterans Affair Patient Population. Ann. Thorac. Surg., 1997, 64, p. 134-141.
Go to original source...
Go to PubMed...
- Krohn, B. G., Kay, J. H., Mendez, M. A. et al. Rapid sustained recovery after cardiac operations. J. Thorac. Cardiovasc. Surg., 1990, 100, p. 194-197.
Go to original source...
Go to PubMed...
- Engelman, R. M., Rousou, J. A., Flack, J. E. et al. Fast-track recovery of the coronary bypass patient. Ann. Thorac. Surg., 1994, 58, p. 1742-1746.
Go to original source...
Go to PubMed...
- Brucek, P. J., Straka, Z., Vanek, T., Jares, M. Less invasive cardiac anesthesia: an ultra-fast-track procedure avoiding thoracic epidural analgesia. Heart Surg. Forum, 2003, 6, p. 528-530.
- Vanek, T., Brucek, P., Straka, Z. Fast track as a routine for open-heart surgery. Eur. J. Cardiothorac. Surg., 2002, 21, p. 369-374.
Go to original source...
Go to PubMed...
- Vanek, T., Jares, M., Straka, Z., Brucek, P. Fast-track with alfentanil general anesthesia for open heart surgery: a review of our first 40 valve operations. Anaesth. Intens. Therapy, 2002, 34, p. 5C-7C.
- Brůček, P., Straka, Z., Vaněk, T., Widimský, P. Extubace na operačním sále - nová éra kardioanestezie? Anest. Neodkl. Péče, 2002, 13, s. 63-65.
- Turk, D. C, Melzack, R. Handbook of pain assessment. Second edition New York : Guilford Press, 1992, p. 152-168, ISBN 157230488X.
- Knotek, P., Williams, D. A., Blahuš, P., Šolcová, I., Žalský, M. Standardizovaná česká verze krátké formy Dotazníku bolesti McGillovy univerzity. Bolest, 2001, 3, s. 113-117.
- Ozkose, Z., Cok, O. Y., Tuncer, B., Tufekcioglu, S., Yardim, S. Comparison of Hemodynamics, Recovery Profile Pain control and Costs of Remifentanil Versus Alfentanil-Based Total Intravenous Anesthesia (TIVA). Journal of Clinical Anesthesia, 2002, 14, p. 161-168.
Go to original source...
Go to PubMed...
- Apitzsch, H., Olthoff, D., Tyjeme, V., Wiegel, M., Bohne, V., Vetter, B. Remifentanil und Alfentanil: Symphatiko-adrenerge Efekte in der frühen postoperativen Phase beim kardiovaskulären Risikopatienten. Anaesthesist, 1999, 48, p. 301-309.
Go to original source...
Go to PubMed...
- Ahonen, J., Olk K. T., Verkkala, K., Heikkinen, L., Järvinen, A., Selmenperä, M. A comparison of Remifentanil and Alfentanil for Use with Propofol in Patiens undergoing Minimally Invasive Coronary Artury Bypass Surgery. Anesth. Analg., 2000, 90, p. 1269-1274.
Go to original source...
Go to PubMed...
- Edgerton, J. R., Herbert, M. A., Prince, S. L. et al. Reduced Atrial Fibrillation in Patients Immediately Extubated After Off-Pump Coronary Artery Bypass Grafting. Ann. Thorac. Surg., 2006, 81, p. 2121-2127.
Go to original source...
Go to PubMed...
- Cheng, D. C., Karski, J., Peniston, C. et al. Morbidity outcome in early versus conventional tracheal extubation in the operating room after coronary artery bypass grafting: a prospective randomized controlled trial. J. Thorac. Cardiovasc. Surg., 1996, 112, p. 755-764.
Go to original source...
Go to PubMed...