Abstract
WITH THE escalating numbers of patients requiring cardiac surgery, efficient use of the limited facilities and resources available is vital for the proper delivery of medical care. The evolution of fast-track cardiac anesthesia and efficient resource utilization has resulted in the adoption of early tracheal extubation techniques in cardiac surgical patients. 1 Cheng DCH Fast-track cardiac surgery: Economic implications in postoperative care. J Cardiothorac Vasc Anesth. 1998; 12: 72-79 Abstract Full Text PDF PubMed Scopus (89) Google Scholar , 2 Westaby S Pillai R Parry A et al. Does modern cardiac surgery require conventional intensive care?. Eur J Cardiothorac Surg. 1993; 7: 313-318 Crossref PubMed Scopus (105) Google Scholar Although it has been established that early tracheal extubation is safe, is cost-effective, and can improve resource utilization in cardiac surgery, 3 Cheng DCH Karski J Peniston C et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass graft surgery: A prospective randomized controlled trial. J Thorac Cardiovasc Surg. 1996; 112: 755-764 Abstract Full Text Full Text PDF PubMed Scopus (303) Google Scholar , 4 Cheng DCH Karski J Peniston C et al. Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use: A prospective randomized controlled trial. Anesthesiology. 1996; 85: 1300-1310 Crossref PubMed Scopus (339) Google Scholar questions remain regarding the significance of various perioperative anesthetic techniques on fast-track management or earlier tracheal extubation. In this issue, London et al 5 London MJ Grunwald GK Shroyer AL Grover FL Association of fast-track cardiac management and low-to-moderate-dose glucocorticoid administration with perioperative hyperglycemia. J Cardiothorac Vasc Anesth. 2000; 14: 631-638 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar examine the association of glucocorticoid administration with perioperative hyperglycemia and extubation time in fast-track cardiac management. Alhashemi et al 6 Alhashemi JA Sharpe MD Harris CL et al. Effect of subarachnoid morphine administration on extubation time following coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2000; 14: 639-644 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar investigated the efficacy of an intrathecal morphine technique on early extubation. When applied to the choice of anesthetic techniques, it is necessary to balance the benefits and risks of these techniques against the current fast-track recovery and total costs of the patient's care.
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