Comparison of Ultrafast Tracking Anesthesia versus Conventional Strategy in Postoperative Management of Off-Pump Coronary Artery Bypass Surgery

Abstract

Abstract Introduction Conventional strategy in the postoperative ventilation was a long-established practice in former times but now fast tracking is an acknowledged technique. This study was embarked to assess the impact of ultrafast tracking on patient recovery and length of stay in intensive care unit (ICU) compared with conventional methods in off-pump coronary artery bypass (OPCAB) patients. Methods Fifty patients were enrolled in each group. Exclusion criteria were patients with ejection fraction > 30%, hemodynamically unstable, on intra-aortic balloon pump, associated valvular heart disease, and intraoperative conversion to on-pump coronary artery bypass grafting. Ultrafast tracking of anesthesia (UFTA) protocol included induction with low dose fentanyl, propofol, and vecuronium. Maintenance of anesthesia was done with sevoflurane, fentanyl, and atracurium whereas analgesia was done with tramadol and paracetamol. Results Statistical analysis was done with SPSS 21.0 program. Fischer’s test, chi-square test, independent t-test/Mann–Whitney U tests were used for calculations. Extubation time was statistically significant (p = 0.0001). Shift to ward was 3.96 ± 0.73 days in UFTA group and 4.34 ± 0.66 days in conventional group which proved statistically significant (p = 0.0073). No patients in both groups had postoperative myocardial infarction, stroke, low cardiac output, or mediastinitis. Renal failure and mortality were 2% in conventional group. Hypothermia, pacemaker dependency, blood transfusion, inotrope score, atrial fibrillation, re-exploration, and reintubation were monitored. No reintubation occurred in UFTA group. Conclusion UFTA appears to be safe and effective in OPCAB patients with early shift from ICU without any major complications.