Fast-track Cardiac Care for Adult Cardiac Surgical Patients

master's thesis

• Title (croatian): Brza kardijalna procjena bolesnika za kardijalni zahvat
• Author: Maria Jose Riera Manzano
• Mentor: Vilena Vrbanović Mijatović (mentor)
• Committee member: Vilena Vrbanović Mijatović (predsjednik povjerenstva)
• Committee member: Daniela Bandić Pavlović (član povjerenstva)
• Committee member: Dinko Tonković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Cardiac anaesthesiology is a specialized branch of anaesthesiology focused on the care of patients undergoing heart surgery. In the late 1980s and early 1990s, the concept of fast-track cardiac anaesthesia (FTCA) began to be introduced because a search to improve recovery times and reduce cost was being carried out. After some clinical trials the benefits such as reduction in Intensive Care Unit (ICU) length of stay (LOS) and additionally, in the hospital, and improvement in patient satisfaction without
compromising morbidity or mortality, were demonstrated and allowed the implementation by the early 2000s.
FTCA emerged as a response to the need for more efficient, cost-effective and patientcentered care in cardiac surgery, and includes optimized anaesthesia, early extubation and early mobilization, all of which contribute to rapid recovery. The protocol uses low-dose opioids, volatile anaesthetic agents, and short-acting neuromuscular blockers to provide quick sedation, reversal and hemodynamic stability while facilitating early extubation within 1-10 hours after surgery.
In this thesis, fast-track and conventional anaesthetic protocols are compared, highlighting FTCA’s benefits, and identifying potential complications and predictors of failure while stating the extubation criteria, perioperative goals and risk factors.
In conclusion, FTCA offers significant advantages in cardiac surgery, including economic benefits from shorter hospital stays and better patient outcomes. Despite challenges and risks, careful patient selection and strict perioperative management are crucial for successful FTCA implementation. Continuous research and improvements are necessary to further enhance its effectiveness and patient care in surgery.

Abstract (croatian)

Kardijalna anesteziologija je specijalizirana grana anesteziologije usmjerena na skrb o pacijentima podvrgnutim operacijama srca. Koncept brze kardijalne anestezije (FTCA) se počeo uvoditi krajem 1980-ih i početkom 1990-ih godina, ne bi li se skratilo vrijeme oporavka i smanjili troškovi liječenja. Kliničkim ispitivanjaima su prikazane prednosti poput smanjenja duljine boravka u jedinici intenzivnog liječenja (ICU) i dodatno, u bolnici, te poboljšanje zadovoljstva pacijenata bez utjecaja na morbiditet ili mortalitet, što je omogućilo implementaciju početkom 2000-ih.
FTCA se pojavila kao odgovor na potrebu za učinkovitijom, isplativijom i na pacijenta usmjerenom skrbi u kardijalnoj kirurgiji, a uključuje optimiziranu anesteziju, rano ekstubiranje i ranu mobilizaciju, što sve doprinosi brzom oporavku. Protokol uključuje niske doze opioida, hlapljive anestetike i kratkodjelujuće neuromuskularne blokatore kako bi se osigurala brza sedacija, povratak svijesti i hemodinamska stabilnost, omogućujući u isto vrijeme rano ekstubiranje unutar 1-10 sati nakon operacije.
U ovom radu uspoređuju se protokoli brze i konvencionalne anestezije, ističući prednosti FTCA i identificirajući potencijalne komplikacije i prediktore neuspjeha, i navodeći kriteriji za ekstubiranje, perioperativni ciljevi i čimbenici rizika.
Zaključno, FTCA nudi značajne prednosti u kardijalnoj kirurgiji, uključujući ekonomske koristi od kraćeg boravka u bolnici i bolje ishode za pacijente. Unatoč izazovima i rizicima, pažljiv odabir pacijenata i strogo definirano perioperativno zbrinjavanje ključni su za uspješnu implementaciju FTCA. Kontinuirano istraživanje i unapređenja nužni su za daljnje poboljšanje njegove učinkovitosti i skrbi za pacijente tijekom operacije.

• Keywords: fast-track; adult; cardiac surgical procedures; early extubation; anaesthesia
• Keywords (croatian): ubrzana skrb; odrasli; kardijalni kirurški zahvati; rano ekstubiranje; anestezija
• Language: english
• URN:NBN: urn:nbn:hr:105:320008
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-10-21 08:24:25