Ultra-fast-track anesthesia in cardiac surgery: perioperative outcomes, patient selection, and implementation strategies—a narrative review

Ultra-fast-track anesthesia (UFTA) is an approach characterized by early endotracheal extubation-typically at the end of surgery or within the first hour after surgery-with the aim of facilitating rapid emergence and early restoration of physiological function in patients undergoing cardiac surgery. Short-acting sedatives, neuromuscular blockade reversal strategies, and regional analgesic techniques have expanded the anesthesiologist's perioperative toolkit and may support selected UFTA pathways; however, they are adjuncts rather than prerequisites, and evidence that any single component independently improves UFTA success remains limited. In carefully selected patients, UFTA has been associated with shorter invasive ventilation and may reduce ICU resource use in selected settings. However, reported effects on ICU or hospital length of stay, pulmonary complications, reintubation, and mortality are heterogeneous, and most available evidence remains susceptible to selection and institutional confounding. This review summarizes UFTA as a multidisciplinary cardiovascular surgery pathway, focusing on perioperative outcomes, patient selection, implementation strategies, and evidence gaps relevant to safe adoption.