Effects of multimodal low-opioid anesthesia protocol during on-pump coronary artery bypass grafting: a prospective cohort study.

Humans Analgesics, Opioid Atrial Fibrillation / etiology Coronary Artery Bypass, Off-Pump / adverse effects Cardiac Output, Low Prospective Studies Interleukin-6 Coronary Artery Bypass / adverse effects Anesthesia / adverse effects Postoperative Complications / prevention & control
Cardiopulmonary bypass Coronary artery bypass grafting IL-6 Low cardiac output syndrome Multimodal low-opioid anesthesia protocol Postoperative atrial fibrillation

Journal

Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113

Informations de publication

Date de publication:
06 Oct 2023
Historique:
received: 01 02 2023
accepted: 30 09 2023
medline: 1 11 2023
pubmed: 7 10 2023
entrez: 6 10 2023
Statut: epublish

Résumé

The most favorable anesthesia protocol during on-pump coronary artery bypass grafting (CABG) in patients with coronary heart disease remains unclear, despite previous publications regarding the interaction between anesthesia protocol and postoperative complications. The aim of the study was to compare the effect of a multimodal low-opioid anesthesia protocol (MLOP) on early postoperative complications during on-pump CABG. A single-center prospective cohort study including 120 patients undergoing on-pump CABG aged 18 to 65 years, divided into two groups according to undergoing MLOP or routine-opioid anesthesia protocol (ROP). The analyzed parameters were plasma IL-6 levels, complications, duration of mechanical ventilation, length of intensive care unit stay, and hospitalization. In the MLOP group, the levels of IL-6 at the end of the surgery were 25.6% significantly lower compared to the ROP group (33.4 ± 9.4 vs. 44.9 ± 15.9, p < 0.0001), the duration of mechanical ventilation was significantly shorter (2.0 (2.0; 3.0) h vs. 4.0 (3.0; 5.0) h, p < 0.001), the incidence of low cardiac output syndrome was almost two and half times lower (7 (11.7%) vs. 16 (26.7%), p = 0.037), and also the incidence of postoperative atrial fibrillation was significantly lower (9 (15.0%) vs. 19 (31.7%), p = 0.031). Our study confirms that using MLOP was characterized by significantly lower levels of IL-6 at the end of surgery and a lower incidence of low cardiac output syndrome and postoperative atrial fibrillation than ROP. The study is registered in clinicaltrials.gov №NCT05514652.

Sections du résumé

BACKGROUND BACKGROUND
The most favorable anesthesia protocol during on-pump coronary artery bypass grafting (CABG) in patients with coronary heart disease remains unclear, despite previous publications regarding the interaction between anesthesia protocol and postoperative complications. The aim of the study was to compare the effect of a multimodal low-opioid anesthesia protocol (MLOP) on early postoperative complications during on-pump CABG.
METHODS METHODS
A single-center prospective cohort study including 120 patients undergoing on-pump CABG aged 18 to 65 years, divided into two groups according to undergoing MLOP or routine-opioid anesthesia protocol (ROP). The analyzed parameters were plasma IL-6 levels, complications, duration of mechanical ventilation, length of intensive care unit stay, and hospitalization.
RESULTS RESULTS
In the MLOP group, the levels of IL-6 at the end of the surgery were 25.6% significantly lower compared to the ROP group (33.4 ± 9.4 vs. 44.9 ± 15.9, p < 0.0001), the duration of mechanical ventilation was significantly shorter (2.0 (2.0; 3.0) h vs. 4.0 (3.0; 5.0) h, p < 0.001), the incidence of low cardiac output syndrome was almost two and half times lower (7 (11.7%) vs. 16 (26.7%), p = 0.037), and also the incidence of postoperative atrial fibrillation was significantly lower (9 (15.0%) vs. 19 (31.7%), p = 0.031).
CONCLUSION CONCLUSIONS
Our study confirms that using MLOP was characterized by significantly lower levels of IL-6 at the end of surgery and a lower incidence of low cardiac output syndrome and postoperative atrial fibrillation than ROP.
TRIAL REGISTRATION BACKGROUND
The study is registered in clinicaltrials.gov №NCT05514652.

Identifiants

DOI: 10.1186/s13019-023-02395-y PMID: 37803334 PMC: PMC10559440
pubmed: 37803334
doi: 10.1186/s13019-023-02395-y
pii: 10.1186/s13019-023-02395-y
pmc: PMC10559440
doi:

Substances chimiques

Analgesics, Opioid 0
Interleukin-6 0

Banques de données

ClinicalTrials.gov
['NCT05514652']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

272

Informations de copyright

© 2023. BioMed Central Ltd., part of Springer Nature.

Références

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Auteurs

Maruniak Stepan (M)

Department of Extracorporeal Methods of Treatment, Heart Institute Ministry of Health of Ukraine, Bratyslavska str. 5A, Kyiv, 02166, Ukraine. maruniak.stepan@gmail.com.
Department of Anaesthesiology and Intensive Care, Shupyk National Healthcare University of Ukraine, Bratyslavska str. 3 A, Kyiv, PL, 02166, Ukraine. maruniak.stepan@gmail.com.
Department of Respiratory Medicine, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany. maruniak.stepan@gmail.com.

Loskutov Oleh (L)

Department of Extracorporeal Methods of Treatment, Heart Institute Ministry of Health of Ukraine, Bratyslavska str. 5A, Kyiv, 02166, Ukraine.
Department of Anaesthesiology and Intensive Care, Shupyk National Healthcare University of Ukraine, Bratyslavska str. 3 A, Kyiv, PL, 02166, Ukraine.

Druzhyna Oleksandr (D)

Department of Extracorporeal Methods of Treatment, Heart Institute Ministry of Health of Ukraine, Bratyslavska str. 5A, Kyiv, 02166, Ukraine.
Department of Anaesthesiology and Intensive Care, Shupyk National Healthcare University of Ukraine, Bratyslavska str. 3 A, Kyiv, PL, 02166, Ukraine.

Swol Justyna (S)

Department of Respiratory Medicine, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.

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