Fast-Tracking in Cardiac Surgery—Is It the Patient or the Protocol?

Fast-track anaesthesia in cardiac and transplant surgeries- An Indian perspective

“…It has been reported that patients with low co-morbidity scores undergoing less complicated surgery can be considered for FTCA. 5 Additionally, those undergoing a first elective coronary artery bypass graft (CABG) or valvular surgery and having good left ventricular function, no history of myocardial infarction (MI) within 30 days before the surgery, and no systemic disease like renal failure or chronic obstructive pulmonary disease can be considered for FTCA.1 A low EuroSCORE is also a predictor of successful FTCA. 11 According to cardiac anaesthesia experts, most patients can be considered for FTA except those with compromised airways.…”

“…Neuromuscular monitoring can diagnose neuromuscular blocks and minimize peri-operative complications in patients undergoing liver transplantation. 5…”

“…19,36 Some centres use a PACU-centric model, whereby suitable patients are pre-identified to bypass the ICU. 5 It has been reported that treatment in a specialised PACU rather than an ICU after elective cardiac surgery leads to earlier extubation and quicker discharge to a step-down unit, without compromising patient safety. 37 However, according to the Indian cardiac and transplant anaesthesia experts, though PACU is a valuable concept, currently no major centres in India have introduced it.…”

“…4 Various studies have reported several advantages of FTA, such as shorter duration of postoperative mechanical ventilation, decrease in the incidence of VAP, shorter ICU and hospital LOS, and even mortality. 2,5,6 A previous study showed that liver transplantation recipients did not always need ICU care after surgery. 7 A 2016 Cochrane systematic review of adults undergoing cardiac surgery reported that fast-track cardiac anaesthesia (FTCA) reduced ICU stay with no significant difference in mortality rate or major complications between patients managed under FTCA protocols and conventional protocols.…”

Fast-Track Failure After Cardiac Surgery: Risk Factors and Outcome With Long-Term Follow-Up

“…7,9,11,12 These risk factors seem to be influenced mainly by local factors. 15 In 2011, our institution implemented an ERACS program that relies on a PACU-centric fasttrack cardiac surgery protocol. There is no general definition of the term 'fast-track' although in most studies it is a combination of early extubation and the use of short-acting opioids and hypnotic drugs to reduce ICU and hospital length-of-stay.…”