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High-dose versus low-dose opioid anesthesia in adult cardiac surgery: A meta-analysis
- Source :
- Journal of clinical anesthesia. 57
- Publication Year :
- 2019
-
Abstract
- Study Objective. We performed a systematic comparison of high-dose and low-dose opioid anesthesia in cardiac surgery. Design Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting Operating room. Patients 1400 adult patients undergoing cardiac surgery using general anesthesia. Interventions All RCTs comparing the effects of various doses of intravenous opioids (morphine, fentanyl, sufentanil, and remifentanil) during adult cardiac surgery using general anesthesia published until May 2018 (full-text English articles reporting data from human subjects) were included. Measurements Primary outcome was intensive care unit (ICU) length of stay (LOS). Secondary outcomes were ventilation time, use of vasopressors, perioperative myocardial infarction, perioperative stroke, and hospital LOS. Main results Eighteen articles were included (1400 patients). There was no difference in ICU LOS between studies using high or low dose of opioids (both short-acting and long-acting) (standard mean difference [SMD]−0.02, 95%CI: −0.15–0.11, P = 0.74). Similarly, there was no difference in secondary outcomes of ventilation time (SMD−0.27, 95%CI: −0.63–0.09, P = 0.14), use of vasopressors (OR 0.61, 95%CI: 0.29–1.30, P = 0.20), myocardial infarction (risk difference 0.00, 95% CI: −0.02–0.03, P = 0.70), stroke (RD 0.00, 95% CI: −0.01–0.01, P = 0.92) and hospital LOS (SMD 0.03, 95% CI: −0.26–0.33, P = 0.84). At meta-regression, there was no effect of age, gender, or type of opioid on the difference between groups. Conclusions Our data suggest that low-dose opioids, both short acting and long acting, are safe and effective to use in adult cardiac surgery patients, independent of the clinical characteristics of the patients and the type of opioid used. In view of the current opioid epidemic, low-dose opioid anesthesia should be considered for cardiac surgery patients.
- Subjects :
- Adult
medicine.medical_specialty
Remifentanil
Anesthesia, General
Fentanyl
law.invention
Sufentanil
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
030202 anesthesiology
law
medicine
Humans
030212 general & internal medicine
Cardiac Surgical Procedures
Stroke
Randomized Controlled Trials as Topic
Dose-Response Relationship, Drug
business.industry
Perioperative
Length of Stay
medicine.disease
Intensive care unit
Cardiac surgery
Analgesics, Opioid
Intensive Care Units
Anesthesiology and Pain Medicine
Anesthesia
business
medicine.drug
Subjects
Details
- ISSN :
- 18734529
- Volume :
- 57
- Database :
- OpenAIRE
- Journal :
- Journal of clinical anesthesia
- Accession number :
- edsair.doi.dedup.....3f9bb71fabd9271413e75ea57feac800