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Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study
- Source :
- BMC Anesthesiology, BMC Anesthesiology, BioMed Central, 2021, 21 (1), pp.166. ⟨10.1186/s12871-021-01362-1⟩, BMC Anesthesiology, Vol 21, Iss 1, Pp 1-11 (2021), BMC Anesthesiology, 2021, 21 (1), pp.166. ⟨10.1186/s12871-021-01362-1⟩
- Publication Year :
- 2021
- Publisher :
- HAL CCSD, 2021.
-
Abstract
- Background No previous study investigated the dexmedetomidine-based opioid-free anesthesia (OFA) protocol in cardiac surgery. The main objective of this study was to evaluate the feasibility and the postoperative opioid-sparing effect of dexmedetomidine-based OFA in adult cardiac surgery patients. Methods We conducted a single-centre and retrospective study including 80 patients above 18 years old who underwent on-pump cardiac surgery between November 2018 and February 2020. Patients were divided into two groups: OFA (lidocaine, ketamine, dexmedetomidine, MgSO4) or opioid-based anaesthesia (remifentanil and anti-hyperalgesic medications such as ketamine and/or MgSO4 and/or lidocaine at the discretion of the anesthesiologist). The primary endpoint was the total amount of opioid consumed in its equivalent of intravenous morphine during the first 48 postoperative hours. Secondary outcomes included perioperative hemodynamics, post-operative maximal pain at rest and during coughing and adverse outcomes. Data are expressed as median [interquartile range]. Results Patients in the OFA-group had a higher EuroSCORE II, with more diabetes, more dyslipidemia and more non-elective surgery but fewer smoking history. In the OFA group, the median loading dose of dexmedetomidine was 0.6 [0.4–0.6] μg.kg− 1 while the median maintenance dose was 0.11 μg.kg− 1.h− 1 [0.05–0.20]. In 10 (25%) patients, dexmedetomidine was discontinued for a drop of mean arterial pressure below 55 mmHg. The median total amount of opioid consumed in its equivalent of intravenous morphine during the first 48 postoperative hours was lower in the OFA group (15.0 mg [8.5–23.5] versus 30.0 mg [17.3–44.3], p p = 0.60), the maximal pain score during coughing was lower in OFA group (3.5 [2.0–5.0] versus 5.5 [3.0–7.0], p = 0.04). In OFA group the incidence of atrial fibrillation (18% versus 40%, p = 0.03) and non-invasive ventilation use (25% versus 48%, p = 0.04) were lower. The incidence of bradycardia and the intraoperative use of norepinephrine were similar between both groups. Conclusion Dexmedetomidine-based OFA in cardiac surgery patients is feasible and could be associated with a lower postoperative morphine consumption and better postoperative outcomes. Further randomized studies are required to confirm these promising results and determine the optimal associations, dosages, and infusion protocols during cardiac surgery. Graphical abstract
- Subjects :
- Male
Mean arterial pressure
Lidocaine
[SDV]Life Sciences [q-bio]
Remifentanil
Pain
030204 cardiovascular system & hematology
Loading dose
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
Anesthesiology
medicine
Humans
Hypnotics and Sedatives
Ketamine
Anesthesia
RD78.3-87.3
Dexmedetomidine
Cardiac Surgical Procedures
Aged
Retrospective Studies
Opioid-free anaesthesia
Pain, Postoperative
Morphine
Maintenance dose
business.industry
Research
Perioperative
Middle Aged
Cardiac surgery
3. Good health
Analgesics, Opioid
[SDV] Life Sciences [q-bio]
Anesthesiology and Pain Medicine
Feasibility Studies
Female
France
business
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 14712253
- Database :
- OpenAIRE
- Journal :
- BMC Anesthesiology, BMC Anesthesiology, BioMed Central, 2021, 21 (1), pp.166. ⟨10.1186/s12871-021-01362-1⟩, BMC Anesthesiology, Vol 21, Iss 1, Pp 1-11 (2021), BMC Anesthesiology, 2021, 21 (1), pp.166. ⟨10.1186/s12871-021-01362-1⟩
- Accession number :
- edsair.doi.dedup.....afd4714ddace3ff962ede998a4daeb06