Fast tracking is an approach to health care delivery that emphasizes the efficient use of resources.
This approach has been applied to the treatment of liver transplant patients to see if the length of time such patients require mechanical ventilation and intensive care after liver transplantation can be reduced.
Following Institutional Review Board approval, and informed consent, Dr David J. Plevak and colleagues from the Department of Anesthesiology and Critical Care at the Mayo Clinic, investigated the effect of using shorter-acting drugs and different drug administration practices on a study group of 80 consecutive patients.
The patients, all older than 17 years, and undergoing liver transplantation, were randomized to receive either traditional anesthetic (thiopental, pancuronium, 50 µg/kg fentanyl), or fast track anesthetic (propofol, cisatracurium, 20 µg/kg fentanyl).
The patients were weaned to extubation in the intensive care unit after an established clinical protocol.
Measured data included the occurrence of intra-operative hypotension, intra-operative hypertension, and intra-operative tachycardia.
| Postoperative ventilation time:|
- Traditional anesthetic 1,081 minutes
- Fast-track anesthetic 553.5 minutes
| Liver Transplantation |
The length of postoperative mechanical ventilation, length of intensive care unit stay, and episodes of reintubation were also measured.
A total of 78 patients remained in the study through the investigation (2 died intra-operatively).
Operating time, amount of intra-operative red blood cells transfused, lowest body temperature achieved, and minutes of intra-operative hypotension were not different between the traditional and fast track patient groups.
Hypertension and tachycardia also showed no difference between the 2 study groups.
Postoperative ventilation time was found to be greater in the patients who received the traditional anesthetic; mean 1,081 minutes (median, 855 minutes) versus mean 553.5 minutes (median, 390 minutes).
However, there was no difference in length of intensive care unit stay.
5 patients required reintubation (2 patients given the traditional anesthetic, 3 given the fast track anesthetic).
Writing in the August issue of the journal Liver Transplantation the authors conclude that a fast track approach to anesthetic care reduces the requirement for postoperative mechanical ventilation, but does not reduce intensive care unit stay after liver transplantation.