The incidence of intraoperative awareness in cardiac surgery fast-track treatment.

OBJECTIVE

To determine the occurrence of intraoperative awareness with recall in cardiac surgery patients undergoing fast-track anesthetic management in a direct-admission postanesthetic care unit.

DESIGN

Prospective.

SETTING

University-affiliated heart center.

PARTICIPANTS

Five hundred thirty-four patients undergoing fast-track anesthesia.

INTERVENTIONS

Using a structured interview process as part of the quality-assurance program.

METHODS AND MAIN RESULTS

All fast-track patients during an 8-month period were entered into the study at a university hospital. Each patient was interviewed by research staff with the same standard set of questions within the first 24 hours of surgery. Follow-up interviews were performed on day 3 or 4 as well as on day 6 or 7 postsurgery. Awareness was defined by the presence of explicit memory of any event from the induction of anesthesia to the recovery of consciousness in the postanesthetic care unit (PACU). A final study population of 514 patients was evaluated. None of the answers given by any patient during any of the 3 interviews indicated intraoperative awareness, with the exception of one 54-year-old male patient. Most likely, this potential awareness did not take place during the operation but was caused by inadequate awakening in the PACU.

CONCLUSION

Therefore, the authors conclude that, with respect to intraoperative awareness, the "Leipzig Fast-Track Concept" with the use of ultra-short-acting opioids should be considered as a safe method of management of patients undergoing a wide variety of cardiac operations.