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Published on: May 26, 2015
The fast-track anesthesia protocol in patients undergoing thoracoscopic radiofrequency ablation of atrial
Han Xu1, Minghan Wang2, Peiling Wan1
1Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Objectives:
To investigate the safety and effectiveness of fast-track anesthesia (FTA) compared with non-FTA in patients undergoing thoracoscopic atrial fibrillation (AF) radiofrequency ablation surgery and to preliminarily evaluate the risk factors for FTA failure.
Methods:
Forty-two patients undergoing elective thoracoscopic AF radiofrequency ablation surgery were included in this retrospective observational study, and they were divided into FTA and non-FTA group based on the anesthetic protocol. The perioperative information of the two groups was compared, with postoperative hospital stay as the primary endpoint. Univariate logistic regression analysis was used to analyze the factors associated with the failure of the FTA protocol.
Results:
Of the 42 patients, 33 successfully completed the FTA protocol and returned to the ward after surgery, while 9 patients underwent the non-FTA protocol and continued recovery in the intensive care unit. In the FTA group, postoperative hospital stay and total hospital stay were shorter (6.3 ± 0.6 vs 7 (7,8.5), P = 0.01 and 8 (7.5,10) vs 14 (11.5, 14), P = 0.00), and medical costs were lower (87800.9 (86303.6,93991.4) vs 98165.1 ± 2116.5, P = 0.00). Furthermore, opioid consumption was lower (0.5 ± 0.1 vs 0.7 (0.6,1.7), P = 0.00), nerve block implementation rate was higher (97 % vs 33.3 %, P = 0.00), postoperative extubation was earlier (13 (5,40) vs 626.1 ± 130.2, P = 0.00), gastrointestinal function and mobility were recovered earlier (1 (0.5,1) vs 1 (1,1.5), P = 0.00) in the FTA group. The univariate logistic regression analysis revealed that Age (OR: 1.15, 95 %CI: 1.01,1.30, P < 0.05), women (Men vs women, OR: 0.14, 95 %CI: 0.03,0.81, P < 0.05), NYHA Class III(OR: 16, 95 %CI: 1.41,180.90, P < 0.05), chronic AF with slow ventricular rate (OR: 6.25, 95 %CI: 1.26,30.90, P < 0.05), and CHA2DS2VASc score (OR: 2.02, 95 %CI: 1.2,3.5, P < 0.05) were predictors of the FTA failure.
Conclusion:
The FTA protocol is safe and beneficial in patients undergoing thoracoscopic AF radiofrequency ablation surgery. Elderliness, female sex, chronic AF with slow ventricular rate, NYHA Class III and high CHA2DS2VASc scores may be the contributing factors for FTA failure.
