Effect of ultra-fast-track cardiac anesthesia on vasoactive-inotropic support after coronary artery bypass grafting

Background: Ultra-fast-track cardiac anesthesia (UFTCA) aims to promote rapid tracheal extubation and has increasingly been incorporated into enhanced recovery protocols after coronary artery bypass grafting (CABG). Nevertheless, its influence on early postoperative hemodynamic stability, particularly in terms of vasoactive-inotropic requirements, remains insufficiently defined. Methods: In this study with a prospective, randomized design, adult patients scheduled for elective isolated CABG were assigned in a 1:1 ratio to either immediate extubation in the operating theater (UFTCA group) or conventional extubation in the intensive care unit (ICU). All participants received standardized general anesthesia combined with ultrasound-guided thoracic paravertebral and femoral nerve blocks. The primary endpoint was the cumulative vasoactive-inotropic score (VIS) within the first 24 hours postoperatively. Secondary endpoints included ICU and hospital length of stay, time to mobilization, chest tube removal, postoperative pain, nausea and vomiting, delirium, and quality of recovery evaluated using the quality of recovery-15 (QoR-15). Results: . 3.97±2.82; p<0.05). Additionally, ICU and hospital stay durations, time to mobilization, and chest tube removal occurred earlier in the UFTCA cohort. QoR-15 scores were significantly improved in the UFTCA group. Postoperative pain scores, rescue analgesic use, nausea, vomiting, and delirium rates did not differ significantly. No reintubation or respiratory complications were observed following ultra-fast-track management. Conclusion: Immediate extubation using an UFTCA strategy was associated with reduced vasoactive-inotropic support requirements and improved early recovery metrics after CABG, without compromising safety.