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Li M, Li X, Wu Y, Zhang T, Li M, Chen Y. The Effects of Different Doses of Sufentanil on Intraoperative Cardiovascular Response and Postoperative Recovery in Patients Undergoing Cardiac Surgery: A Retrospective Cohort Study. Drug Des Devel Ther 2024; 18:535-547. [PMID: 38415195 PMCID: PMC10898255 DOI: 10.2147/dddt.s449200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024] Open
Abstract
Objective To investigate the correlation between the amount of sufentanil used during anesthesia and intraoperative hemodynamic fluctuation and postoperative recovery in patients undergoing cardiopulmonary bypass (CPB). Materials and Methods A retrospective analysis was performed on 454 patients undergoing elective heart surgery under CPB. Patients were divided into two groups according to the amount of sufentanil used during anesthesia: Group L (induced sufentanil 0.4-0.6 ug /kg, maintained sufentanil 0.01-0.02 ug/kg/min, n = 223) and Group H (induced sufentanil 4-6 ug/kg, maintained sufentanil 0.02-0.03 ug/kg/min, n = 231). Propensity score matching (PSM) was used at a 1:1 nearest-neighbor ratio to compare the two groups. Intraoperative use of vasoactive drugs, spontaneous heart rebound, secondary endotracheal intubation, postoperative mechanical ventilation time, the length of stay (LOS) in ICU, postoperative LOS in hospital, postoperative in-hospital mortality were analyzed. Results After matching, a total of 144 patients were included (72 patients in Group L, and 72 patients in Group H). Multivariate logistic regression analysis showed that the dosage of sufentanil during anesthesia was significantly correlated with the utilization rate of intraoperative vasoactive drugs (P < 0.001) and the success rate of spontaneous heart rebound (p = 0.001). The utilization rate of vasoactive drugs decreased significantly in Group H (OR, 0.062; 95% CI, 0.019-0.200) compared to that of Group L. The success rate of spontaneous heart rebound (OR, 0.187; 95% CI, 0.071-0.491) was higher in Group H. There were no differences on postoperative recovery outcomes between the two groups. Conclusion On the basis of our data, the use of high-dose sufentanil is beneficial to keep the cardiovascular response of patients in a stable state, but there is no significant effect on the quality of early postoperative recovery.
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Affiliation(s)
- Meng Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Xue Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Yong Wu
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Tianyu Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Mengya Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
| | - Ying Chen
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People's Republic of China
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Malachauskiené L, Bhavsar RP, Waldemar J, Strøm T. Effect of Interpectoral-Pectoserratus Plane (PECS II) Block on Recovery Room Discharge Time in Breast Cancer Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:41. [PMID: 38256302 PMCID: PMC10819446 DOI: 10.3390/medicina60010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The increase in the incidence and diagnosis rate of breast cancer demands the optimization of resources. The aim of this study was to assess whether the supplementation of the interpectoral-pectoserratus plane block (PECS II) reduces surgery and post-anesthesia care unit (PACU) time in patients undergoing breast cancer surgery. Materials and methods: This was a retrospective data-analysis study. In 2016, PECS II block was introduced as a supplement to general anesthesia for all mastectomies with or without axillary resections in South Jutland regional hospital, Denmark. The perioperative data of patients operated 3 years before and 3 years after 2016 was retrieved through the Danish anesthesia database and patient journals and systematically analyzed. Female patients aged over 18 years, with no use of muscle relaxant, intubation, and inhalation agents, were included. The eligible data was organized into two groups, i.e., Block and Control, where the Block group received PECS II Block, while the Control group received only general anesthesia. Parameters such as surgery time, anesthesia time, PACU time, opioid consumption, and the incidence of postoperative nausea and vomiting (PONV) in PACU were retrieved and statistically analyzed. Results: A total of 172 patients out of 358 patients met eligibility criteria. After applying exclusion criteria, 65 patients were filtered out. A total of 107 patients, 51 from the Block and 56 from the Control group, were eligible for the final analysis. The patients were comparable in demographic parameters. The median surgery time was significantly less in the Block group (78 min (60-99)) in comparison to the Control group (98.5 min (77.5-139.5) p < 0.0045). Consequently, the median anesthesia time was also shorter in the Block group (140 min (115-166)) vs. the Control group (160 min (131.5 to 188), p < 0.0026). Patients from the Block group had significantly lower intraoperative fentanyl consumption (60 µg (30-100)) as compared with the Control group (132.5 µg (80-232.5), p < 0.0001). The total opioid consumption during the entire procedure (converted to morphine) was significantly lower in the Block group (16.37 mg (8-23.6)) as compared with the Control group (31.17 mg (16-46.5), p < 0.0001). No statistically significant difference was found in the PACU time, incidences of PONV, and postoperative pain. Conclusions: The interpectoral-pectoserratus plane (PECS II) block supplementation reduces surgery time, anesthesia time, and opioid consumption but not PACU time during breast cancer surgery.
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Affiliation(s)
- Laima Malachauskiené
- Department of Anesthesia and Critical Care Medicine, South Jutland Regional Hospital, Kresten Philipsens Vej 15, DK-6200 Aabenraa, Denmark; (L.M.); (T.S.)
| | - Rajesh Prabhakar Bhavsar
- Department of Anesthesia and Critical Care Medicine, South Jutland Regional Hospital, Kresten Philipsens Vej 15, DK-6200 Aabenraa, Denmark; (L.M.); (T.S.)
| | - Jacob Waldemar
- Odense Medical College, Odense University, Campusvej 55, DK-5230 Odense, Denmark;
| | - Thomas Strøm
- Department of Anesthesia and Critical Care Medicine, South Jutland Regional Hospital, Kresten Philipsens Vej 15, DK-6200 Aabenraa, Denmark; (L.M.); (T.S.)
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Kann SH, Thomassen SA, Abromaitiene V, Jakobsen CJ. ICU Nurses-An Impact Factor on Patient Turnover in Cardiac Surgery in Western Denmark? J Cardiothorac Vasc Anesth 2021; 36:1967-1974. [PMID: 34736863 DOI: 10.1053/j.jvca.2021.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to describe changes in performance indicators such as length of stay [LOS] in the intensive care unit [ICU] and ventilation time, during the last six years in an attempt to identify associations between patient and systemic performance indicators, including the impact of nurse turnover. DESIGN A retrospective study of prospectively registered data (2013-2018). Propensity- score matching was performed to establish comparable groups. SETTING Three Danish university hospitals. PARTICIPANTS The study included a total of 12,404 adult cardiac surgical patients registered in the Western Denmark Heart Registry. The cohort was divided into an "early" group (2013-2016) and a "late" group (2017-2018). INTERVENTIONS An analysis of dynamics in patient indicators and systemic performance indicators, including the impact from selected performance parameters and nurse turnover. MEASUREMENTS AND MAIN RESULTS Comorbidity, calculated from the European System for Cardiac Operative Risk Evaluation, and the mean age were stable in the study period. Strong predictors of long LOS in the ICU included postoperative use of inotropes, re-exploration surgery, high postoperative drainage, and the "late" time group. Time parameters (relative risks) were all significantly longer in the "late" time group": ventilation time 1.21 (1.05-1.39), length of stay ICU 1.28 (1.11-1.48), and in-hospital time 1.36 (1.19-1.57). ICU nurse turnover increased from four (2013-2014) to 52 (2017-2018). CONCLUSION No single patient factor, such as age or comorbidity, could explain the decrease in patient turnover in the ICU. In the same period, the turnover of ICU nurses increased. Patient turnover is complex and affected by a mix of patient and systemic performance factors.
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Affiliation(s)
- Sigrun Høegholm Kann
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
| | - Sisse Anette Thomassen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Vijoleta Abromaitiene
- Department of Anesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Carl-Johan Jakobsen
- Department of Anesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Bartholmes F, M. Malewicz N, Ebel M, K. Zahn P, H. Meyer-Frießem C. Pupillometric Monitoring of Nociception in Cardiac Anesthesia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:833-840. [PMID: 33593477 PMCID: PMC8021968 DOI: 10.3238/arztebl.2020.0833] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 12/19/2019] [Accepted: 05/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND High-dose opioids are conventionally used for cardiac anesthesia, but without monitoring of nociception. In non-cardiac surgical procedures the intra - operative dose of opioids can be individualized and reduced with pupillometric monitoring of the pupillary pain index (PPI; scale 1-9). A randomized controlled trial was carried out to explore whether pupillometry can be used for nociception monitoring in cardiac anesthesia and whether it leads to opioid reduction. METHODS A sample of 57 cardiac surgery patients receiving continuously administered sufentanil (initial dosage 0.7 μg*kg-¹*h-¹) was divided into a PPI group (sufentanil reduction if PPI<3 up to a minimum of 0.15 μg*kg-¹*h-¹, n=32) and a control group (standard anesthesia; n = 25). The primary outcome was the time from the end of anesthesia to extubation. The secondary outcomes were total intraoperative dose of sufentanil/noradrenaline, postoperative pain intensity (numeric rating scale [NRS] 0-10) and intraoperative awareness. German Clinical Trials Registry no. DRKS 00012329. RESULTS The primary outcome, extubation time, did not differ between the two groups (1.14 h, 95% confidence interval [-0.99; 3.27], p = 0.592). Compared with the control patients (68% male, age 70 ± 10.4 years, PPI 1.1 ± 0.2), the mean sufentanil infusion rate in the PPI patients (81% male, age 68 ± 10.3 years, PPI 1.1 ± 0.2) decreased by 81.8% (-0.68 μg*kg-¹*h-¹ [-0,7; -0.67], p<0.001) to the predetermined minimum level, without intraoperative awareness. Moreover, the noradrenaline dose was reduced by 56% (1235.51 μg [321.91; 2149.12], p = 0.005) and the postoperative pain intensity by 45% (2.11 NRS [0.93; 3.3] after 24 h, p = 0.003). CONCLUSION Pupillometry is appropriate for nociception monitoring in cardiac anesthesia. Thereby a considerable reduction of intraoperative opioids as well as increased intraoperative hemodynamic stability was achieved and postoperative opioid-induced hyperalgesia was prevented. The consistently low PPI scores, indicating adequate analgesia, suggest that further reduction of opioid doses is feasible.
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Affiliation(s)
- Felix Bartholmes
- BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Klinik für Anästhesie, Intensiv- und Schmerzmedizin
| | - Nathalie M. Malewicz
- BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Klinik für Anästhesie, Intensiv- und Schmerzmedizin
| | - Melanie Ebel
- BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Klinik für Anästhesie, Intensiv- und Schmerzmedizin
| | - Peter K. Zahn
- BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Klinik für Anästhesie, Intensiv- und Schmerzmedizin
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Bhavsar R, Ryhammer PK, Greisen J, Jakobsen CJ. Fast-track cardiac anaesthesia protocols: Is quality pushed to the edge? Ann Card Anaesth 2020; 23:142-148. [PMID: 32275026 PMCID: PMC7336968 DOI: 10.4103/aca.aca_204_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The quest for methods expediting rapid postoperative patient turnover has triggered implementation of various fast-track cardiac anaesthesia protocols. Using three different fast-track protocols in randomized controlled studies (RCT) conducted 2010-2016 we found minimal achievements in ventilation time together with actual and eligible length of stay in cardiac recovery unit. The comparable control group patients were evaluated in this retrospective post hoc analysis, for an association between above mentioned parameters and quality parameters, to assess whether the marginal gains have been at the expense of quality of recovery and patient comfort. Method 90 control patients from three RCT with comparable demographic parameters and receiving standard department treatment were evaluated using time parameters and an objective/semi-objective Intensive Care Unit (ICU) score system (IDS score). Results Ventilation time was statistical significant lower in latest study (C) than the early (A) and intermedium (B) studies (A=293, B=261, C=205 minutes; P=0.04). The IDS was lower at extubation and all time points in the early study compared to other studies (P < 0.001;). The average IDS in latest study were the double of previous studies at the end of observations, and marginally above the acceptable score for discharge. The postoperative morphine requirement A=15.0, B=10.0 and C=26.5 mg; P=0.002) was statistical significant higher in the latest study compared to previous studies. Conclusion The implementation of strict fast-track protocols resulting in shorter ventilation time did not convert to earlier eligibility to discharge from the ICU. However, the quality of recovery appears challenged.
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Affiliation(s)
- Rajesh Bhavsar
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Pia K Ryhammer
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Jacob Greisen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Carl-Johan Jakobsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Bhavsar R, Jakobsen CJ. The Major Decrease in Resource Utilization in Recent Decades Seems Guided by Demographic Changes: Fast Tracking-Real Concept or Demographics. J Cardiothorac Vasc Anesth 2019; 34:1476-1484. [PMID: 31679999 DOI: 10.1053/j.jvca.2019.09.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/21/2019] [Accepted: 09/25/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify dynamics of associations and potential areas for optimization of patient turnover between various patient profile and comorbidity indicators and selected system performance indicators such as ventilation time, length of stay in the intensive care unit, and in-hospital stay. DESIGN Retrospective study of prospectively registered data (2000-2017). SETTING Three university hospitals. PARTICIPANTS The study comprised 38,100 adult cardiac surgical patients registered in the Western Denmark Heart Registry. INTERVENTIONS Analysis of dynamics in patient indicators and system performance indicators, including effect on the selected performance parameters. MEASUREMENTS AND MAIN RESULTS Comorbidity, calculated from EuroSCORE, decreased from 2.5 ± 2.2 to 1.5 ± 2.0 (p < 0.001), whereas the average age of patients increased from 65.1 ± 9.9 years to 67.6 ± 10.8 years (p < 0.001). Median ventilation time decreased from 380 to 275 minutes (p < 0.0001). The mean length of stay in the intensive care unit demonstrated a statistically significant decrease from 35.1 hours between 2000 to 2002 to 31.8 hours between 2015 to 2017 (p = 0.004), and the median time was unchanged at 22.0 hours throughout the observation period. The median in-hospital stay decreased from 6.5 to 5.1 days (p < 0.001) and the mean in-hospital stay from 8.7 days (2003-2005) to 7.0 days (2015-2017; p < 0.001). Logistic regression analysis of performance factors showed a statistically significant negative independent effect on most comorbidity and surgical factors. CONCLUSION The increase in performance parameters appears to be highly associated with decreased comorbidities and fast-tracking protocols and may only offer limited effect in additional patient turnover.
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Affiliation(s)
- Rajesh Bhavsar
- Surgery and Intensive Care East, Aarhus University Hospital, Aarhus, Denmark
| | - Carl-Johan Jakobsen
- Surgery and Intensive Care East, Aarhus University Hospital, Aarhus, Denmark.
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Yu J, Xiang B, Song Y, Chen H, Li Y, Liu C. ED50 of propofol in combination with low-dose sufentanil for intravenous anaesthesia in hysteroscopy. Basic Clin Pharmacol Toxicol 2019; 125:460-465. [PMID: 31231918 DOI: 10.1111/bcpt.13280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/03/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Sufentanil has favourable pharmacodynamic and pharmacokinetic properties as an opioid, and it is usually co-administered with propofol as intravenous anaesthesia for hysteroscopic examination or therapeutic surgery. However, the optimal dosage of propofol when it is co-administered with low-dose sufentanil has not yet been established. This study was designed to find the median effective dose of propofol for intravenous anaesthesia when combined with low-dose sufentanil. METHODS Fifty-four patients were enrolled and randomized into two groups in this prospective study. Sufentanil 0.2 μg/kg (Group A) or 0.1 μg/kg (Group B) was given intravenously before speculum placement. The initial propofol dose was set at 2 mg/kg and varied by 0.1 mg/kg according to the sequential allocation up-and-down rule designed by Dixon and Massey. Respiratory depression, duration of initial dose of propofol, total drug quantity administered and recovery time were recorded. RESULTS The ED50 of propofol was 1.651 mg/kg (95% CI, 1.561-1.722 mg/kg) in Group A and 1.991 mg/kg (95% CI, 1.902-2.081 mg/kg) in Group B. The ED95 of propofol was 1.827 mg/kg (95% CI, 1.746-2.236 mg/kg) in Group A and 2.153 mg/kg (95% CI, 2.070-2.73 7 mg/kg) in Group B. The initial and total dosage of propofol in Group A were significantly lower than those in Group B, but the incidence of respiratory depression in Group A (26.67%) was significantly higher than that in Group B (4.17%). CONCLUSION The ED50 values for propofol when co-administered with low-dose sufentanil for intravenous anaesthesia in hysteroscopy were 1.651 mg/kg (sufentanil 0.2 μg/kg) and 1.991 mg/kg (sufentanil 0.1 μg/kg). (www.chictr.org.cn, registration number: ChiCTR1900021224).
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Affiliation(s)
- Jin Yu
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Bo Xiang
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yun Song
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Hu Chen
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Youchang Li
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Chun Liu
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Chongqing, China
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Li N, Chen Y, Ouyang B, Li G, Lin G, Li Y, Li T. The optimal bolus dose of sufentanil for satisfactory laryngeal mask airway (LMA) insertion conditions in chinese pediatric patients: A prospective double-blind randomized controlled trial (CONSORT). Medicine (Baltimore) 2019; 98:e14711. [PMID: 30855463 PMCID: PMC6417634 DOI: 10.1097/md.0000000000014711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study aimed to estimate the optimal dose of sufentanil, coadministered with 2.5 mg/kg propofol, for satisfactory laryngeal mask airway (LMA) insertion conditions in Chinese children and to determine the optimal bolus dose. METHODS Seventy-five Chinese children aged 2 to 6 years with the American Society of Anesthesiologists physical status I or II, undergoing elective minor surgery were recruited. They were randomly divided into 5 different dosage groups (0, 0.05, 0.1, 0.15, 0.2 μg/kg). A predetermined sufentanil diluted with 5 mL saline was injected 30 s, 200 s later, followed by 2.5 mg/kg propofol over 10 s. After that the insertion conditions were assessed, using a 6-category score. The duration of apnea was recorded. A Probit analysis was performed to determine the ED50 and ED95 with 95% confidence interval for optimal conditions. RESULTS There were less hemodynamic changes in all sufentanil groups than propofol-only group, with 0.2 μg/kg patients showing the most stable cardiovascular responses and best insertion conditions. However, the duration of apnea increased with the increasing dosage of sufentanil. From Probit analysis, the ED50 and ED95 of sufentanil for optimum score were 0.064 μg/kg and 0.177 μg/kg, respectively. CONCLUSION In combination with propofol for anesthesia induction in Chinese children, sufentanil 0.2 μg/kg could prevent patients from dramatic hemodynamic change, providing satisfactory LMA insertion conditions.
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Zakhary WZA, Turton EW, Flo Forner A, von Aspern K, Borger MA, Ender JK. A comparison of sufentanil vs. remifentanil in fast-track cardiac surgery patients. Anaesthesia 2019; 74:602-608. [PMID: 30663045 PMCID: PMC6590640 DOI: 10.1111/anae.14572] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2018] [Indexed: 11/30/2022]
Abstract
We retrospectively compared patients receiving remifentanil with patients receiving sufentanil undergoing fast-track cardiac surgery. After 1:1 propensity score matching there were 609 patients in each group. The sufentanil group had a significantly longer mean (SD) ventilation time compared with the remifentanil group; 122 (59) vs. 80 (44) min, p < 0.001 and longer mean (SD) length of stay in the recovery area; 277 (77) vs. 263 (78) min, p = 0.002. The sufentanil group had a lower mean (SD) visual analogue pain score than the remifentanil group; 1.5 (1.2) vs. 2.4 (1.5), p < 0.001 and consumed less mean (SD) piritramide (an opioid analgesic used in our hospital); 2.6 (4.7) vs. 18.9 (7.3) mg, p < 0.001. The results of our study show that although remifentanil was more effective in reducing time to tracheal extubation and length of stay in the recovery area, there was an increased requirement for postoperative analgesia when remifentanil was used.
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Affiliation(s)
- W Z A Zakhary
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, Leipzig, Germany
| | - E W Turton
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, Leipzig, Germany
| | - A Flo Forner
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, Leipzig, Germany
| | - K von Aspern
- University Department for Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - M A Borger
- University Department for Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - J K Ender
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, Leipzig, Germany
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Fedosova M, Kimose HH, Greisen JR, Fast P, Gissel MS, Jakobsen CJ. Blood cardioplegia benefits only patients with a long cross-clamp time. Perfusion 2018; 34:42-49. [PMID: 30044166 DOI: 10.1177/0267659118790914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A clear advantage of blood versus crystalloid cardioplegia has not yet been observed in smaller population studies. The purpose of this article was to further investigate the clinical outcomes of blood versus crystalloid cardioplegia in a large propensity-matched cohort of patients who underwent cardiac surgery. METHODS The study was a single-centre study. Data was withdrawn from the Western Denmark Heart Registry, which comprises a perfusion section for each procedure. A total of 4,852 patients were propensity matched into crystalloid (CC) vs blood cardioplegia (BC) groups. The primary end points were creatinine kinase-MB (CKMB) elevation, acute myocardial infarction (AMI), stroke, dialysis, coronary angiography (CAG) and mortality (30 days and 6 months). RESULTS We found lower odds ratio in 30-day mortality in the BC group (OR 0.21; CI 0.06-0.68), but no difference in overall 6-month mortality. There was no difference in CKMB elevation, AMI, dialysis or stroke. Several end points were further analysed for different cross-clamp times. In the CC group, ventilation time above 600 minutes was seen more often in almost all cross-clamp time intervals (23.5 % vs 12.2 %; p<0.0001; χ2-test) and 6-month mortality was significantly higher when the cross-clamp time exceeded 210 minutes (64.3 vs 23.8; p=0.018; χ2-test). CONCLUSIONS We did not find clear evidence of superiority of either type in the uncomplicated patient. When prolonged cross-clamp time or postoperative ventilation is expected, this study indicates that blood cardioplegia might be preferable.
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Affiliation(s)
- Maria Fedosova
- 1 Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Hans-Henrik Kimose
- 2 Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Raben Greisen
- 1 Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Fast
- 1 Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Carl-Johan Jakobsen
- 1 Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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