Influence of fast-track anesthetic technique on cardiovascular infusions and weight gain.

OBJECTIVE: To evaluate whether cardiac surgical patients receiving conventional versus fast-track anesthetic management are statistically significantly different with regard to cardiovascular drug infusions, weight gain, cardiac and pulmonary morbidity, length of intubation, and length of stay.

DESIGN: Retrospective, (partially) sequential, cohort design.

SETTING: Surgical suite and intensive care unit (ICU) at a community hospital.

PARTICIPANTS: Two hundred seven patients who presented for coronary artery bypass graft and/or cardiac valve replacement.

INTERVENTIONS: None

MEASUREMENTS AND MAIN RESULTS: Group comparisons of the seven individual cardiovascular drug infusions showed less frequent use in the fast-track patients for lidocaine (9% v 28%; p = 0.00046) only. However, the fast-track group received fewer combinations of cardiovascular drug infusions overall for the first 24-hour postoperative period (p < 0.0005). Hourly comparisons of inotropes showed significantly fewer combinations of dobutamine, norepinephrine, and epinephrine for the first postoperative hour and for postoperative hours 7 through 12 (p < 0.01 for each hour). Fast-track patients had less postoperative weight gain for days 1 through 4 (p < 0.01 for each day), shorter length of ICU stay (p < 0.00005), and shorter total length of postoperative hospital stay (p = 0.0004). No differences were found with respect to myocardial infarction, death, pulmonary complications, rate of reintubation, or length of hospital stay once discharged from the ICU.

CONCLUSIONS: Fast-track anesthetic management may be associated with decreased need for inotropic and antiarrhythmic drug infusions and decreased weight gain.