Abstract
Many kinds of anesthetic regimens are employed for fast-track cardiovascular surgery. We introduce our fast-track anesthesia method using remifentanil aimed for tracheal extubation in the operation room after cardiovascular surgery. Anesthesia was induced and maintained by target controlled infusion of propofol(in cases using cardiopulmonary bypass(CPB)) or sevoflurane(in cases not using CPB) with remifentanil infusion 0.3mcg/kg/min. Intravenous fentanyl infusion 0.5μg/kg/hr was started at about 2 hours before the end of surgery for postoperative analgesia. After the surgery, patients were awaken and extubated if chest X-ray didn’t show any abnormal signs. Tracheal extubation in the operation room was achieved 58.3% of patients, and no severe complication was observed. Compared with having been possible for the operating room extubation as for 76.5% of cardiac surgery, the vascular surgery was able to do the operating room extubation only 14.3%(p=0.005). However, when the cases which were able to carry out the extubation was included within 4 hours after ICU entering, the extubation was possible for 83.3% of total cases. Thus, this anesthetic method with remifentanil could be used as one of regimens for fast-track cardiovascular anesthesia.
