The incidence of intraoperative awareness in cardiac surgery fast-track treatment.

Objective: To determine the occurrence of intraoperative awareness with recall in cardiac surgery patients undergoing fast-track anesthetic management in a direct-admission postanesthetic care unit.

Design: Prospective.

Setting: University-affiliated heart center.

Participants: Five hundred thirty-four patients undergoing fast-track anesthesia.

Interventions: Using a structured interview process as part of the quality-assurance program.

Methods And Main Results: All fast-track patients during an 8-month period were entered into the study at a university hospital. Each patient was interviewed by research staff with the same standard set of questions within the first 24 hours of surgery. Follow-up interviews were performed on day 3 or 4 as well as on day 6 or 7 postsurgery. Awareness was defined by the presence of explicit memory of any event from the induction of anesthesia to the recovery of consciousness in the postanesthetic care unit (PACU). A final study population of 514 patients was evaluated. None of the answers given by any patient during any of the 3 interviews indicated intraoperative awareness, with the exception of one 54-year-old male patient. Most likely, this potential awareness did not take place during the operation but was caused by inadequate awakening in the PACU.

Conclusion: Therefore, the authors conclude that, with respect to intraoperative awareness, the "Leipzig Fast-Track Concept" with the use of ultra-short-acting opioids should be considered as a safe method of management of patients undergoing a wide variety of cardiac operations.