Enhanced Recovery After Cardiac Surgery.

Area of Science:

• Anesthesiology
• Cardiac Surgery
• Critical Care Medicine

Background:

• "Fast track" cardiac anesthesia aims to reduce time to tracheal extubation and hospital discharge in select patients.
• Current evidence supporting these protocols is largely based on observational, nonrandomized data and expert opinion.
• Key outcomes studied include extubation time, hospital/ICU length of stay, financial costs, and peri-operative opioid use.

Purpose of the Study:

• To evaluate the current evidence base for "fast track" cardiac anesthesia.
• To highlight the need for improved research quality in enhanced recovery protocols for cardiac surgery.
• To advocate for tailoring enhanced recovery principles to all cardiac surgical patients.

Main Methods:

• Review of existing literature on "fast track" cardiac anesthesia and enhanced recovery protocols.
• Analysis of commonly studied outcomes such as extubation time, length of stay, costs, and opioid consumption.
• Emphasis on the limitations of current evidence derived from nonrandomized studies.

Main Results:

• The evidence supporting "fast track" cardiac anesthesia is currently weak.
• Recommendations are predominantly based on observational data and expert consensus rather than high-quality trials.
• Significant variability exists in the outcomes measured and the patient populations studied.

Conclusions:

• A shift towards generating higher-quality evidence is crucial for enhanced recovery protocols in cardiac surgery.
• Further research should focus on adapting enhanced recovery principles for broader application in cardiac surgical patients.
• Future research should prioritize patient quality of care and public healthcare delivery.