王伟鹏 中德交流 Status and outcomes of Fast Track Cardiac Anesthesia概要1.pptxVIP

Status and outcomes of Fast Track Cardiac Anesthesia in Fuwai Hospital;2012CSA, Chongqing, China;Reduce the hospital stay Progress of surgical experience Peri-operative managements;;;;;Fast On the track Comfortable Efficient Good service Cost effective;The main driving force is Economics in changing health care delivery in the 90s The motto is to do more with less Medical staffs have to seek the way to cut down the medical cost and ensure good recovery of patients;No universal criteria Most accepted definition 6hr extubation Early mobilization Discharge from ICU on postop. day No1 Discharge from hospital on postop. day No5;;4-10 μ g/kg Reduce the dose of narcotics Improve postoperative analgesia Facilitate early extubation in cardiac surgery 10 μg/kg found to prolong ventilatory depression;Early recovery of consciousness and spontaneous ventilation Hemodynamic stability Superior analgesia Reduced oxygen demand;Awake CABG with TEA;C7-T1/T1-T2 Test dose 3 ml 2% lidocaine Intra operative analgesia 0.25% bupivacaine + fentanyl Post operative analgesia 0.125% bupivacaine + fentanyl ;Prospective RCT 62 COPD patients divided in two groups Undergoing elective OPCAB Aim To find out the beneficial effects of TEA in patients of COPD undergoing elective OPCAB;Conclusion Early Extubation (10.81 hrs/ 13.5 hrs) Better postop analgesia Better postop ABG Better postoperative PFT Early withdrawal of supplemental oxygen (26.26 / 29.87 hrs);TEA is commonly used for postoperative analgesia It is safe and effective technique In skilled and experienced hands Guidelines regarding anticoagulated patients are followed Some centers are also using TEA as primary anesthetic techniques for cardiac surgery; As many as 28% of cases are complicated by a pneumothorax 8% of cases need additional infiltration with local anesthesia The conversion rate to GA with ET ranged from 0-10% ;Recent fast truck method in Japan ;OPCAB surgery is here to stay Clinical evidence demonstrates