Ultra-fast-track cardiac anesthesia in minimally invasive cardiac surgery: a retrospective observational study.

Abstract

Background: There is no uniformity on the safety profile of ultra-fast-track cardiac anesthesia (UFTCA), and there is a lack of research on the postoperative lung function status of patients with UFTCA. This retrospective study was to examine the benefits of UFTCA on the postoperative recovery and pulmonary function of patients undergoing minimally invasive cardiac surgery (MICS).

Methods: This retrospective study was performed on patients who underwent MICS at Zhejiang Provincial People's Hospital between January 2022 and July 2023. Patients were retrospectively segregated into two groups: UFTCA group and conventional general anesthesia (CGA group). Primary endpoints encompassed differences in the duration of postoperative intensive care unit (ICU) stay and overall hospital stay. Secondary observations included in-hospital mortality rate, 3-month post-discharge survival rate, oxygenation indexes of preoperative (T0), immediately after extubation (T1), 6 hours after extubation (T2), and 12 hours after extubation (T3), use of high-flow nasal cannula oxygen therapy in the ICU, postoperative total chest drainage volume, and the rate of complications. Group comparisons were performed using grouped t-tests and repeated measures analysis of variance (ANOVA).

Results: The UFTCA group (n=327) demonstrated shorter ICU and hospital stays when compared with the CGA group (n=216) (P=0.001). At the immediately after extubation, the UFTCA group exhibited a decrease in oxygenation index [arterial oxygen partial pressure (PaO₂)/fraction of inspired oxygen (FiO₂)] accompanied by elevated alveolar-arterial oxygen tension difference [P(A-a)O₂] and respiratory index [P(A-a)O₂/PaO₂] values compared to the CGA group (P=0.001). However, by 12 hours after extubation, the UFTCA group manifested an improved PaO₂/FiO₂ and diminished P(A-a)O₂/PaO₂ values compared to the CGA group. The UFTCA group required high-flow oxygen therapy after extubation with greater frequency than the CGA group (P=0.001). However, neither the UFTCA nor CGA group had patients who needed reintubation (P>0.05). No significant differences were observed in postoperative atelectasis and pulmonary edema rates between the groups (P>0.05), the UFTCA group recorded a diminished total chest drainage volume postoperatively (P=0.001). Incidence of postoperative nausea and vomiting (PONV) was heightened in the UFTCA group (P=0.01), while the incidence of delirium was less frequent when compared with the CGA group (P=0.001).

Conclusions: UFTCA demonstrates potential benefits in minimizing ICU and postoperative hospital stay in patients undergoing MICS. This approach also contributes to a reduction in postoperative chest drainage volume and a decreased likelihood of postoperative delirium. Despite the initial decline in lung oxygenation immediately following early post-extubation, subsequent lung function proves to be superior, with no differences in postoperative atelectasis or pulmonary edema rates. However, the implementation of UFTCA requires additional strategies to prevent the occurrence of PONV.