Myles Paul S, McIlroy David
Department of Anaesthesia & Pain Management, Alfred Hospital, Victoria, Australia.
Semin Cardiothorac Vasc Anesth. 2005 Mar;9(1):5-16. doi: 10.1177/108925320500900102.
Fast-track cardiac anesthesia (FTCA) incorporates early tracheal extubation, decreased length of intensive care unit (ICU) and hospital stay, and (ideally) should avoid or reduce complications to safely achieve cost-savings. A growing body of evidence from randomized trials has identified many anesthetic interventions that can improve outcome after cardiac surgery. These include new short-acting hypnotic, opioid, and neuromuscular blocking drugs. An effective FTCA program requires the appropriate selection of suitable patients, a low-dose opioid anesthetic technique, early tracheal extubation, a short stay in the ICU, and coordinated perioperative care. It is also dependent on the avoidance of postoperative complications such as excessive bleeding, myocardial ischemia, low cardiac output state, arrhythmias, sepsis, and renal failure. These complications will have a much greater adverse effect on hospital length of stay and healthcare costs. A number of clinical trials have identified interventions that can reduce some of these complications. The adoption of effective treatments into clinical practice should improve the effectiveness of FTCA.
快速通道心脏麻醉（FTCA）包括早期气管拔管、缩短重症监护病房（ICU）住院时间和住院总时长，并且（理想情况下）应避免或减少并发症，以安全实现成本节约。越来越多来自随机试验的证据表明，许多麻醉干预措施可改善心脏手术后的预后。这些措施包括新型短效催眠药、阿片类药物和神经肌肉阻滞药物。有效的FTCA方案需要适当选择合适的患者、采用低剂量阿片类麻醉技术、早期气管拔管、缩短ICU住院时间以及进行围手术期协调护理。它还取决于避免术后并发症，如出血过多、心肌缺血、低心排血量状态、心律失常、败血症和肾衰竭。这些并发症对住院时长和医疗费用的负面影响要大得多。多项临床试验已确定了一些可减少其中某些并发症的干预措施。将有效治疗方法应用于临床实践应可提高FTCA的有效性。
