Influence of fast-track anesthetic technique on cardiovascular infusions and weight gain

To evaluate whether cardiac surgical patients receiving conventional versus fast-track anesthetic management are statistically significantly different with regard to cardiovascular drug infusions, weight gain, cardiac and pulmonary morbidity, length of intubation, and length of stay.

Retrospective, (partially) sequential, cohort design.

Surgical suite and intensive care unit (ICU) at a community hospital.

Two hundred seven patients who presented for coronary artery bypass graft and/or cardiac valve replacement.

None

Group comparisons of the seven individual cardiovascular drug infusions showed less frequent use in the fast-track patients for lidocaine (9% v 28%; p = 0.00046) only. However, the fast-track group received fewer combinations of cardiovascular drug infusions overall for the first 24-hour postoperative period (p < 0.0005). Hourly comparisons of inotropes showed significantly fewer combinations of dobutamine, norepinephrine, and epinephrine for the first postoperative hour and for postoperative hours 7 through 12 (p < 0.01 for each hour). Fast-track patients had less postoperative weight gain for days 1 through 4 (p < 0.01 for each day), shorter length of ICU stay (p < 0.00005), and shorter total length of postoperative hospital stay (p = 0.0004). No differences were found with respect to myocardial infarction, death, pulmonary complications, rate of reintubation, or length of hospital stay once discharged from the ICU.

Fast-track anesthetic management may be associated with decreased need for inotropic and antiarrhythmic drug infusions and decreased weight gain.