The effect of fast-tracking on neurological complications post-cardiopulmonary bypass.

Abstract

With the push to get patients through the system in five days, most patients undergoing nonemergency coronary artery bypass grafting (CABG) are being "fast-tracked'. Using this anaesthetic regimen appears to keep patients less anaesthetized (light) during cardiopulmonary bypass (CPB) than when using our previous regimen. This is manifested by higher mean arterial pressures (maintained above 65 mmHg) during CPB. If patients are receiving less anaesthesia during CPB, they may have an increased cerebral metabolism. This could lead to decreased cerebral oxygenation with a resultant neurological deficit postoperatively. A retrospective analysis of 200 patients who underwent nonemergency CABG was conducted to evaluate postoperative neurological complications. The patients were matched by surgeon, procedure and CPB time. They were separated into two groups: group 1 had maintained mean arterial pressures greater than 65 mmHg on CPB (n = 100) and group 2 had pressures less than 65 mmHg (n = 100). Group 1 had two patients (2%) who exhibited neurological complications after CPB (delirium, continuous coma for at least 24 h) with both of these patients previously having noted cerebrovascular disease. Group 2 also had two patients (2%) with postoperative neurological complications (delirium, transient stroke) with one patient having cerebrovascular disease. From our study, we cannot say that fast-tracking increases the risk for postoperative neurological complications. This could be due to the fact that we maintained the mean venous oxygen saturation during CPB above 70%. More specific testing needs to be done to truly rule out any negative postoperative effect.