Anesthesia

While there are established strategies and guidelines for enhanced recovery after general surgical procedures, there is no such strategy for cardiac surgery. This is probably because of the complexity of the procedure and the wide range of complications which can occur. To achieve enhanced recovery, the aims should be to have a conscious, rational, alert patient as soon as sedation is reduced, hemodynamically stable, pain free, without other complications, and ready to be mobilized. Multi organ complications and problems are quite common after cardiac surgery such as myocardial infarctions 22%, delirium 46% and AKI 30%. Pre-operative optimization of correctable factors, optimal amount of anesthetic and analgesic, goal directed fluid therapy, maintenance of cerebral perfusion are strategies to be employed. For this, monitoring of cardiac output, fluid status, depth of anaesthesia, cerebral function, cerebral oximetry, cardiac function, coagulation function, level of Hb, in addition to usual routine monitoring would be required. Adequate pain relief and optimal sedation, physiotherapy, early mobilizations are required in the post-operative period.