Cheng D C, Newman M F, Duke P, Wong D T, Finegan B, Howie M, Fitch J, Bowdle T A, Hogue C, Hillel Z, Pierce E, Bukenya D
Division of Cardiac Anesthesia & Intensive Care, Toronto General Hospital, University of Toronto, Toronto, Ontario.
Anesth Analg. 2001 May;92(5):1094-102. doi: 10.1097/00000539-200105000-00004.
We compared (a) the perioperative complications; (b) times to eligibility for, and actual time of the following: extubation, less intense monitoring, intensive care unit (ICU), and hospital discharge; and (c) resource utilization of nursing ratio for patients receiving either a typical fentanyl/isoflurane/propofol regimen or a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in 304 adults by using a prospective randomized, double-blinded, double-dummy trial. There were no differences in demographic data, or perioperative mortality and morbidity between the two study groups. The mini-mental status examination at postoperative Days 1 to 3 were similar between the two groups. The eligible and actual times for extubation, less intense monitoring, ICU discharge, and hospital discharge were not significantly different. Further analyses revealed no differences in times for extubation and resource utilization after stratification by preoperative risk scores, age, and country. The nurse/patient ratio was similar between the remifentanil/isoflurane/propofol and fentanyl/isoflu-rane/propofol groups during the initial ICU phase and less intense monitoring phase. Increasing preoperative risk scores and older age (>70 yr) were associated with longer times until extubation (eligible), ICU discharge (eligible and actual), and hospital discharge (eligible and actual). Times until extubation (eligible and actual) and less intense monitoring (eligible) were significantly shorter in Canadian patients than United States' patients. However, there was no difference in hospital length of stay in Canadian and United States' patients. We conclude that both anesthesia techniques permit early and similar times until tracheal extubation, less intense monitoring, ICU and hospital discharge, and reduced resource utilization after coronary artery bypass graft surgery.
An ultra-short opioid technique was compared with a standard fast-track small-dose opioid technique in coronary artery bypass graft patients in a prospective randomized, double-blinded controlled study. The postoperative recovery and resource utilization, including stratification of preoperative risk score, age, and country, were analyzed.
我们采用前瞻性随机、双盲、双模拟试验，比较了304例接受快速心脏麻醉的成年患者，分别采用典型的芬太尼/异氟烷/丙泊酚方案或瑞芬太尼/异氟烷/丙泊酚方案时：(a)围手术期并发症；(b)达到以下情况的合格时间和实际时间：拔管、强度较低的监测、重症监护病房(ICU)和出院；以及(c)护理比例的资源利用情况。两个研究组在人口统计学数据、围手术期死亡率和发病率方面没有差异。术后第1至3天两组的简易精神状态检查相似。拔管、强度较低的监测、ICU出院和出院的合格时间和实际时间没有显著差异。进一步分析显示，按术前风险评分、年龄和国家分层后，拔管时间和资源利用没有差异。在最初的ICU阶段和强度较低的监测阶段，瑞芬太尼/异氟烷/丙泊酚组和芬太尼/异氟烷/丙泊酚组的护士/患者比例相似。术前风险评分增加和年龄较大(>70岁)与拔管(合格)、ICU出院(合格和实际)和出院(合格和实际)时间延长相关。加拿大患者拔管(合格和实际)和强度较低监测(合格)的时间明显短于美国患者。然而，加拿大和美国患者的住院时间没有差异。我们得出结论，两种麻醉技术在冠状动脉搭桥手术后，气管拔管、强度较低的监测、ICU和出院的时间相近且较早，资源利用减少。
在一项前瞻性随机、双盲对照研究中，将一种超短效阿片类技术与一种标准的快速小剂量阿片类技术在冠状动脉搭桥患者中进行了比较。分析了术后恢复情况和资源利用情况，包括术前风险评分、年龄和国家的分层。
