Abstract：
The purpose of this study was to investigate the effect of ultra-fast-track cardiac anesthesia (UFTCA) on rapid postoperative recovery in patients undergoing right-thoracoscopic minimally invasive cardiac surgery.
A retrospective observational study.
A single large teaching hospital.
A total of 153 patients who underwent right-thoracoscopic minimally invasive cardiac surgery between January 2021 and August 2021 were enrolled. The inclusion criteria were American Society of Anesthesiologists grade I to III, New York Heart Association (NYHA) cardiac function class I to III, and age ≥18 years. The exclusion criteria were NYHA class IV, local anesthetic allergy, severe pulmonary hypertension (pulmonary arterial systolic pressure, PASP >70 mmHg), age ≤18 years or ≥80 years old, emergency surgery, and patients with incomplete or missing data.
Finally, a total of 122 patients were included and grouped by different anesthesia strategies. Sixty patients received serratus anterior plane block-assisted ultra-fast- track cardiac anesthesia (UFTCA group), and 62 patients received conventional general anesthesia (CGA group). The primary outcomes were lengths of hospital stay and postoperative intensive care unit (ICU) stay. The secondary outcomes were postoperative pain scores, opioids use, postoperative chest tube drainage, and complications.
The intraoperative dosages of sufentanil and remifentanil in the UFTCA group were significantly lower than those in the CGA group (66.25 ± 1.03 µg v 283.31 ± 11.36 µg, p < 0.001; and 1.94 ± 0.38 mg v 2.14 ± 0.99 mg, p < 0.001, respectively). The incidence of postoperative rescue analgesia in the UFTCA group was significantly lower than that in the CGA group (10 patients [16.67%] v 30 patients [48.38%], p < 0.001). In the postoperative ICU, there were fewer patients with pain score Numeric Rating Scale ≥3 in the UFTCA group than that in the CGA group (10 patients [16.67%] v 29 patients [46.78%], p < 0.001). The postoperative extubation time in the UFTCA group was shorter than that in the CGA group (0.3 hours [range, 0.25-0.4 hours] v 13.84 hours [range, 10.25-18.36 hours], p < 0.001). Lengths of ICU stay and hospital stay in the UFTCA group were shorter than those in the CGA group (27.73 ± 16.54 hours v 61.69 ± 32.48 hours, p < 0.001; and 8 days [range, 7-9] v 9 days [range, 8-12], p < 0.001, respectively). Compared with the CGA group, the patients in the UFTCA group had less chest tube drainage within 24 hours after surgery (197.67 ± 13.05 mL v 318.23 ± 160.10 mL, p < 0.001). There were no significant differences in in-hospital mortality, postoperative bleeding, or secondary surgery between the 2 groups. The incidences of postoperative nausea, vomiting, or atelectasis were comparable between the 2 groups.
Serratus anterior plane block-assisted ultra-fast-track cardiac anesthesia can promote rapid postoperative recovery in patients with right-thoracoscopic minimally invasive cardiac surgery. This anesthesia regimen is clinically safe and feasible.
A retrospective observational study.
A single large teaching hospital.
A total of 153 patients who underwent right-thoracoscopic minimally invasive cardiac surgery between January 2021 and August 2021 were enrolled. The inclusion criteria were American Society of Anesthesiologists grade I to III, New York Heart Association (NYHA) cardiac function class I to III, and age ≥18 years. The exclusion criteria were NYHA class IV, local anesthetic allergy, severe pulmonary hypertension (pulmonary arterial systolic pressure, PASP >70 mmHg), age ≤18 years or ≥80 years old, emergency surgery, and patients with incomplete or missing data.
Finally, a total of 122 patients were included and grouped by different anesthesia strategies. Sixty patients received serratus anterior plane block-assisted ultra-fast- track cardiac anesthesia (UFTCA group), and 62 patients received conventional general anesthesia (CGA group). The primary outcomes were lengths of hospital stay and postoperative intensive care unit (ICU) stay. The secondary outcomes were postoperative pain scores, opioids use, postoperative chest tube drainage, and complications.
The intraoperative dosages of sufentanil and remifentanil in the UFTCA group were significantly lower than those in the CGA group (66.25 ± 1.03 µg v 283.31 ± 11.36 µg, p < 0.001; and 1.94 ± 0.38 mg v 2.14 ± 0.99 mg, p < 0.001, respectively). The incidence of postoperative rescue analgesia in the UFTCA group was significantly lower than that in the CGA group (10 patients [16.67%] v 30 patients [48.38%], p < 0.001). In the postoperative ICU, there were fewer patients with pain score Numeric Rating Scale ≥3 in the UFTCA group than that in the CGA group (10 patients [16.67%] v 29 patients [46.78%], p < 0.001). The postoperative extubation time in the UFTCA group was shorter than that in the CGA group (0.3 hours [range, 0.25-0.4 hours] v 13.84 hours [range, 10.25-18.36 hours], p < 0.001). Lengths of ICU stay and hospital stay in the UFTCA group were shorter than those in the CGA group (27.73 ± 16.54 hours v 61.69 ± 32.48 hours, p < 0.001; and 8 days [range, 7-9] v 9 days [range, 8-12], p < 0.001, respectively). Compared with the CGA group, the patients in the UFTCA group had less chest tube drainage within 24 hours after surgery (197.67 ± 13.05 mL v 318.23 ± 160.10 mL, p < 0.001). There were no significant differences in in-hospital mortality, postoperative bleeding, or secondary surgery between the 2 groups. The incidences of postoperative nausea, vomiting, or atelectasis were comparable between the 2 groups.
Serratus anterior plane block-assisted ultra-fast-track cardiac anesthesia can promote rapid postoperative recovery in patients with right-thoracoscopic minimally invasive cardiac surgery. This anesthesia regimen is clinically safe and feasible.
摘要：
目的：本研究的目的是探讨超快通道心脏麻醉（UFTCA）对右胸腔镜微创心脏手术患者术后快速恢复的影响。
方法：回顾性观察研究。
方法：一家大型教学医院。
方法：纳入了在2021年1月至2021年8月期间接受右胸腔镜微创心脏手术的153例患者。入选标准为美国麻醉医师协会I至III级，纽约心脏协会（NYHA）心功能I至III级，年龄≥18岁。排除标准为NYHAIV级,局部麻醉过敏，重度肺动脉高压（肺动脉收缩压，PASP>70mmHg)，年龄≤18岁或≥80岁，急诊手术,以及数据不完整或缺失的患者。
方法：最后，共纳入122例患者,并按不同麻醉策略分组.60例患者接受了前锯肌平面阻滞辅助超快轨道心脏麻醉（UFTCA组），62例患者接受常规全身麻醉(CGA组)。主要结果是住院时间和术后重症监护病房（ICU）住院时间。次要结果是术后疼痛评分，阿片类药物的使用，术后胸腔引流,和并发症。
结果：UFTCA组术中舒芬太尼和瑞芬太尼的剂量明显低于CGA组（66.25±1.03µgv283.31±11.36µg，p<0.001；和1.94±0.38mgv2.14±0.99mg，p分别<0.001)。UFTCA组术后抢救镇痛发生率明显低于CGA组(10例[16.67%]v30例[48.38%],p<0.001)。在术后ICU,UFTCA组疼痛评分数字评定量表≥3的患者少于CGA组(10例[16.67%]v29例[46.78%],p<0.001)。UFTCA组术后拔管时间短于CGA组（0.3小时[范围，0.25-0.4小时]v13.84小时[范围，10.25-18.36小时]，p<0.001)。UFTCA组的ICU住院时间和住院时间短于CGA组（27.73±16.54小时v61.69±32.48小时，p<0.001；和8天[范围，7-9]v9天[范围，8-12],p分别<0.001)。与CGA组相比，UFTCA组患者术后24小时内胸管引流较少(197.67±13.05mLv318.23±160.10mL,p<0.001)。住院死亡率没有显着差异，术后出血,或二次手术2组之间。术后恶心的发生率,呕吐,或肺不张在两组之间具有可比性。
结论：锯肌前平面阻滞辅助超快通道心脏麻醉可促进右胸腔镜微创心脏手术患者术后快速恢复。这种麻醉方案在临床上是安全可行的。
方法：回顾性观察研究。
方法：一家大型教学医院。
方法：纳入了在2021年1月至2021年8月期间接受右胸腔镜微创心脏手术的153例患者。
方法：最后，
结果：UFTCA组术中舒芬太尼和瑞芬太尼的剂量明显低于CGA组（66.25±1.03µgv283.31±11.36µg，
结论：锯肌前平面阻滞辅助超快通道心脏麻醉可促进右胸腔镜微创心脏手术患者术后快速恢复。
