Fast track ultra pro tools 9
Further, intraoperative and postoperative complications were shown to be major determinants of prolonged ICU LOS. Therefore preoperative risk factors other than age of patients are not major predictors when considered with the intraoperative and postoperative process of care variables for early extubation. Only age, intraoperative inotropic use and intra-aortic balloon pump (IABP), and postoperative rapid atrial arrhythmia were found to be independent predictors of failing to meet extubation criteria. In an analysis of 885 consecutive coronary artery bypass graft (CABG) patients who underwent fast track cardiac anesthesia, 75% were found to be extubated within 10 h. Although the literature has shown that intraoperative anesthetic management, duration of cardiopulmonary bypass and of aortic cross clamp, the individual anesthetist, and postoperative intensive care unit (ICU) management can all influence the outcome of patients, these factors have not been incorporated into any cardiac surgery risk predictive model. They hypothesized that postoperative APS reflected the summation effects of surgical skill, anesthetic management, effectiveness of immediate postoperative care, and the preoperative characteristics of the patient. found that the postoperative acute physiology score (APS) was the most powerful predictor of mortality. Several studies have suggested that perioperative morbidity and mortality of cardiac surgical patients are strongly influenced by patients' preoperative severity of illness and postoperative complications. addresses a controversial question:“can anesthetic agents facilitate early extubation and thus reduce intensive care unit and hospital length of stay?” The principal question is “cost containment in fast track cardiac surgery pathways: early extubation or process of care?” The Concepts further our understanding by questioning “should we pre-select patients into fast track cardiac surgery? Or what are the predictive risk factors for early tracheal extubation?” Butterworth et al. In this issue of Anesthesiology London et al. Although it has recently been demonstrated that early tracheal extubation anesthesia is safe, cost beneficial, and can improve resource use in cardiac surgery, questions still remain regarding the significance of early extubation, the process of care on resource utilization, and costs of cardiac surgical care. In this era of cost containment and physician report cards, we are held accountable for patients' outcome in terms of mortality, morbidity, quality of life, length of stay (LOS), and costs of care. The pressure to reduce costs resulted from market forces and health care reform in the 1990s. COST containment and efficient resource use have forced the pendulum back to the debate of early tracheal extubation in cardiac surgical patients and the evolution of value-based anesthesia care.