***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVE To determine if intrathecal opioid decreases time to extubation after coronary artery bypass surgery without compromising postoperative analgesia . DESIGN Prospect i ve r and omized trial . SETTING Veterans Affairs Hospital . PATIENTS 21 ASA physical status III and IV men scheduled for elective coronary bypass surgery , who had not received medications that would impair anticoagulation at the time of surgery . INTERVENTIONS Patients were r and omized to receive 10 micrograms/kg morphine and 25 micrograms fentanyl intrathecally preoperatively ( n = 12 ) or no intrathecal opioid ( n = 9 ) . The latter group received 25 to 50 micrograms/kg fentanyl and 0.05 to 0.1 mg/kg midaxolam intraoperatively , whereas the intrathecal opioid group received intravenous ( i.v . ) fentanyl and midazolam only as needed . Both groups were administered i.v . morphine and midazolam postoperatively as needed by intensive care unit ( ICU ) personnel who were blinded to the treatment group . MEASUREMENTS AND MAIN RESULTS For the first 24 hours postoperatively , pain levels ( 0 = none , to 10 = most severe ) and sedation levels ( 1 = none , to 5 = unconscious ) were measured hourly . The time to extubation and discharge from the ICU was recorded . ECG evidence of myocardial ischemia was noted . Pain scores were low for both groups ( 1.5 ) , but the intrathecal opioid subjects exhibited less sedation than the high-dose fentanyl subjects [ means + /- st and ard deviation ( SD ) of 2.3 + /- 0.4 vs. 2.8 + /- 0.5 , p = 0.03 ] . Extubation time was 12 hours shorter in the intrathecal opioid group ( 2.9 + /- 5.3 vs. 14.7 + /- 6.8 , p = 0.001 ) . The five subjects with a one day ICU stay were all in the intrathecal opioid group ( p = 0.04 ) . The incidence of myocardial ischemia did not differ between the two groups . CONCLUSIONS Intrathecal opioid can facilitate early extubation and discharge from the ICU without compromising analgesia or increasing myocardial ischemia Background : Adaptive support ventilation can speed weaning after coronary artery surgery compared with protocol ized weaning using other modes . There are no data to support this mode of weaning after cardiac valvular surgery . Furthermore , control group weaning times have been long , suggesting that the results may reflect control group protocol s that delay weaning rather than a real advantage of adaptive support ventilation . Methods : R and omized ( computer-generated sequence and sealed opaque envelopes ) , parallel-arm , unblinded trial of adaptive support ventilation versus physician-directed weaning after adult fast-track cardiac valvular surgery . The primary outcome was duration of mechanical ventilation .  Patients aged 18 to 80 yr without significant renal , liver , or lung disease or severe impairment of left ventricular function undergoing uncomplicated elective valve surgery were eligible . Care was st and ardized , except postoperative ventilation . In the adaptive support ventilation group , target minute ventilation and inspired oxygen concentration were adjusted according to blood gases . A spontaneous breathing trial was carried out when the total inspiratory pressure of 15 cm H2O or less with positive end-expiratory pressure of 5 cm H2O . In the control group , the duty physician made all ventilatory decisions . Results : Median duration of ventilation was statistically significantly shorter ( P = 0.013 ) in the adaptive support ventilation group ( 205 [ 141 to 295 ] min , n = 30 ) than that in controls ( 342 [ 214 to 491 ] min , n = 31 ) . Manual ventilator changes and alarms were less common in the adaptive support ventilation group , and arterial blood gas estimations were more common . Conclusion : Adaptive support ventilation reduces ventilation time by more than 2 h in patients who have undergone fast-track cardiac valvular surgery while reducing the number of manual ventilator changes and alarms OBJECTIVES To identify the remifentanil dosing regimen providing safe and optimal anesthetic conditions during coronary artery bypass graft surgery and to evaluate postoperative recovery characteristics . DESIGN Open-label , r and omized , parallel group . SETTING Three centers in the United States . PARTICIPANTS Seventy-two patients with left ventricular stroke volumes > or=50 mL. INTERVENTIONS Patients were r and omized to remifentanil doses of 1 microg/kg/min ( group 1 , n = 23 ) ; 2 microg/kg/min ( group 2 , n = 24 ) , or 3 microg/kg/min ( group 3 , n = 25 ) . Somatic , sympathetic , and hemodynamic responses indicating inadequate anesthesia were treated with bolus doses of remifentanil , 1 to 2 microg/kg , and infusion rate increases , and , if necessary , isoflurane 0.5 % to 1.0 % was added as a rescue anesthetic . In the intensive care unit , the remifentanil infusion was reset to 1 microg/kg/min , with midazolam administered for supplemental sedation and morphine for analgesia . MEASUREMENTS AND MAIN RESULTS The duration s of anesthesia , surgery , and cardiopulmonary bypass were similar for the 3 study groups . In addition , dose of lorazepam premedication , time to loss of consciousness , preoperative left ventricular ejection fraction , age , weight , and sex were similar for the 3 study groups . Remifentanil alone ( infusion and boluses ) prevented and controlled all responses to stimulation in 44 % of group 3 , 37 % of group 2 and 9 % of group 1 patients intraoperatively . Isoflurane ( 0.5%-1 % inspired ) rescue was successful in the remaining patients in each group . Hypotension indicating discontinuation of isoflurane and reductions of remifentanil infusion rates occurred in 64 % to 75 % of all patients . The optimal range of remifentanil infusion was 2 to 4 microg/kg/min with isoflurane to supplement the opioid . Fifty-one patients ( 71 % ) met the criteria for extubation within 6 hours postoperatively ; because of surgical practice differences , only 30 patients ( 59 % ) were actually extubated . CONCLUSIONS After lorazepam premedication , remifentanil infusion ( 2 - 4 microg/kg/min ) supplemented intermittently with low inspired concentrations of isoflurane provided an effective anesthetic regimen for coronary artery bypass graft surgery . Early extubation times were feasible after remifentanil continuous infusions ( 1 - 5 microg/kg/min ) used as the primary anesthetic component intraoperatively and for analgesia ( < or=1 microg/kg/min ) in the immediate postoperative setting INTRODUCTION Fast-track is a method proposed to decrease medical costs through the reduction of patients ' length of stay in the hospital . This study was carried out to assess the risks and benefits of conducting the fast-track method in cardiac anaesthesia and to evaluate the role of continuous infusion of short-acting anaesthetics in a successful fast-track protocol . METHODS 100 cases were divided into two groups . In the fast-track group , fentanyl and propofol infusions were started at induction time and atracurium one hour later . No bolus drug was administered during the operation . Fentanyl infusion was continued up to 12 hours after surgery . The conventional extubation group received fentanyl and pancuronium as bolus doses . The two groups were evaluated for time of alertness and extubation in the intensive care unit , total analgesic dosage administered during the 24 hours after operation , arterial blood gas and peripheral saturation of oxygen before and after extubation . RESULTS Time period between intensive care unit admission and alertness was significantly different in the fast-track ( 1.3 hours ) and control ( 3.3 hours ) groups ( p-value is less than 0.001 ) as well as total time of intubation in the intensive care unit ( 4.3 hours vs. 7 hours ) ( p-value is less than 0.001 ) . No patient of the fast-track group experienced low pressure of arterial oxygen , low saturation of arterial oxygen , high pressure of arterial carbon dioxide or need for reintubation in the first 24 hours after surgery . CONCLUSION Continuous infusion of drugs in the fast-track method facilitates earlier extubation . It maintains continuous sedation and analgesia without increasing respiratory complications Purpose This r and omized clinical equivalence trial was design ed to evaluate health-related quality of life ( HRQoL ) after fast-track treatment for low-risk coronary artery bypass ( CABG ) patients . Methods Four hundred and ten CABG patients were r and omly assigned to undergo either short-stay intensive care treatment ( SSIC , 8 h of intensive care stay ) or control treatment ( care as usual , overnight intensive care stay ) .  HRQoL was measured at baseline and 1 month , and one year after surgery using the multidimensional index of life quality ( MILQ ) , the EQ-5D , the Beck Depression Inventory and the State-Trait Anxiety Inventory . Results At one month after surgery , no statistically significant difference in overall HRQoL was found ( MILQ-score P-value = .508 , overall MILQ-index P-value = .543 , EQ-5D VAS P-value = .593 ) . The scores on the MILQ-domains , physical , and social functioning were significantly higher at one month postoperatively in the SSIC group compared to the control group ( P-value = .049 ; 95%CI : 0.01–2.50 and P-value = .014 , 95 % CI : 0.24–2.06 , respectively ) . However , these differences were no longer observed at long-term follow-up . Conclusions According to our definition of clinical equivalence , the HRQoL of SSIC patients is similar to patients receiving care as usual . Since safety and the financial benefits of this intervention were demonstrated in a previously reported analysis , SSIC can be considered as an adequate fast-track intensive care treatment option for low-risk CABG patients Introduction Ultra-fast track anaesthesia aims at immediate extubation of cardiac surgical patients at the end of the operation . This study compares the effect of ultrafast track anesthesia versus continued postoperative mechanical ventilation on the intensive care unit length of stay . Methods Fifty-two elective adult patients were r and omly allocated into ultrafast track anaesthesia and conventional groups by computer-generated r and om numbers . Redo operations , pre-operative intubation , uncontrolled diabetes , shock/left ventricular ejection fraction < 45 % , pulmonary artery systolic pressure > 55mmHg , creatinine clearance -1 , haemodynamic instability , or those with concerns of postoperative bleeding were excluded . Pre- and intra-operative management was similar and Logistic EuroSCORE II was calculated for all . Intra-operatively , haemodynamic parameters , urine output , oxygen saturation , arterial blood gas analysis , 5-lead electrocardiogram , operative bypass- and cross-clamp time , and opioid consumption were collected . Postoperatively , patients were compared during their intensive care unit stay . Data were analysed by χ²/Fischer exact , unpaired student ’s t-test , univariate two-group repeated measures with post hoc Dunnett 's test , and Mann-Whitney U tests as appropriate . p < 0.05 was considered significant . Results Patients were comparable regarding their peri-operative characteristics and  EuroSCORE  . The intensive care unit stay was shorter in the ultrafast track anaesthesia group [ 57.4 ( 18.6 ) vs. 95 ( 33.6 ) h. p < 0.001 ] , without increasing postoperative renal , respiratory complications rate or reopening rate . Conclusions In this single center  study  , ultrafast track anaesthesia decreased intensive care unit stay without increasing the rate of post-operative complications OBJECTIVE To investigate if early extubation , 2 hours after surgery , would result in more postoperative pain or in an increased use of opioid analgesics  compared with late extubation , 6 hours after surgery . DESIGN Prospect i ve , r and omized study . SETTING Intensive care unit , university hospital . PARTICIPANTS Sixty patients undergoing cardiac surgery with cardiopulmonary bypass . INTERVENTIONS Patients were r and omized into 2 groups : extubation at about 2 ( early ) or 6 ( late ) hours . Anesthesia was based on propofol and remifentanil . There was no epidural analgesia and no local anesthesia in the wound . A bolus of the opioid ketobemidone was administered toward the end of surgery followed by a continuous infusion . MEASUREMENTS AND MAIN RESULTS Pain , provoked during deep breathing or coughing , evaluated with a visual analog scale ( VAS ) going from 0 to 10 , was measured after extubation , and at 8 and 16 hours after surgery . Unprovoked pain was measured hourly . If VAS was greater than 3 , the infusion rate was increased and a bol 
    Output:
    
However , these two fast-track care interventions were not associated with reduced total length of stay in the hospital ( low level of evidence ) .
Low-dose opioid-based general anaesthesia and time-directed extubation protocol s for fast-track interventions have risks of mortality and major postoperative complications similar to those of conventional ( not fast-track ) care , and therefore appear to be safe for use in patients considered to be at low to moderate risk .
These fast-track interventions reduced time to extubation and shortened length of stay in the intensive care unit but did not reduce length of stay in the hospital