Light Versus Heavy Sedation After Cardiac Surgery (original) (raw)
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Analgesia and sedation post-coronary artery bypass graft surgery: a review of the literature
Therapeutics and Clinical Risk Management
This review aimed to study the role of analgesia and sedation after coronary artery bypass graft (CABG) surgery, regarding pain management, assisted respiration, overall postoperative health care, and hospitalization. Data were collected from Pubmed, Scopus, and Cochrane databases. The following terms were used for the search: "analgesia", "sedation", "coronary artery bypass grafting", CABG", and "opioids". Articles between the years 1988 and 2018 were evaluated. Several opioid and non-opioid analgesics used to relieve surgical pain are regarded as critical risk factors for developing pulmonary and cardiovascular complications in all kinds of thoracic surgery, especially CABG procedures. Effective pain management in post-CABG patients is largely dependent on effective pain assessment, type of sedatives and analgesics administered, and evaluation of their effects on pain relief. A significant challenge is to determine adequate amounts of administered analgesics and sedatives for postoperative CABG patients, because patients often order more sedatives and analgesics than needed. The pain management process is deemed successful when patients feel comfortable after surgery, with no negative side effects. However, postoperative pain management patterns have not included many modern methods such as patient-controlled analgesia, and postoperative pain management drugs are still limited to a restricted range of opioid and non-opioid analgesics.
Factors influencing preoperative stress response in coronary artery bypass graft patients
BMC anesthesiology, 2004
BACKGROUND: In many studies investigating measures to attenuate the hemodynamic and humoral stress response during induction of anaesthesia, primary attention was paid to the period of endotracheal intubation since it has been shown that even short-lasting sympathetic cardiovascular stimulation may have detrimental effects on patients with coronary artery disease. The aim of this analysis was, however, to identify the influencing factors on high catecholamine levels before induction of anaesthesia. METHODS: Various potential risk factors that could impact the humoral stress response before induction of anaesthesia were recorded in 84 males undergoing coronary aortic bypass surgery, and were entered into a stepwise linear regression analysis. The plasma level of norepinephrine measured immediately after radial artery canulation was chosen as a surrogate marker for the humoral stress response, and it was used as the dependent variable in the regression model. Accordingly, the mean art...
Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery
Revista Brasileira de Cirurgia Cardiovascular, 2010
Estudo comparativo de duas diferentes modalidades de analgesia controlada pelo paciente após cirurgia cardíaca Comparasion study of two different patientcontrolled anesthesia regiments after heart surgery Abstract Introduction: Acute and severe pain is frequent in patients who undergo heart surgery and patient controlled analgesia (PCA) can be used to manage postoperative pain. Objective: To compare analgesia using PCA without continous infusion with PCA plus a continuous infusion of morphine on postoperative period of heart surgery and to assess pain scores, morphine consumption, number of demand, patient satisfaction and side effects. Methods: Randomized clinical trial was performed to assess patients who had undergone heart surgery who received either PCA with and without intravenous infusion of morphine. In the postoperative period, PCA was started at extubation in both regiments according to randomization. Pain intensity, morphine consumption, number of demand, satisfaction and side effects were assessed at zero, six, twelve, eighteen, twenty four and thirty hours after patients' extubation. Results: The study enrolled 100 patients. 50 patients received PCA without continuous infusion of morphine (Group A), and 50 patients received morphine PCA plus a continuous infusion of morphine (Group B). Group B patients had less demand of morphine, consumed more morphine and were more satisfied regarding analgesia. No statistical differences were found between groups related to pain intensity, and side effects. Conclusions: Pain control was effective and similar in both groups. The same efficacy of analgesia and the less morphine consumption suggest that PCA without continuous infusion of morphine seems to be better option for postoperative pain manage in heart surgery.
Anesthesiology and Pain Medicine, 2016
Background: Major surgeries such as open-heart surgery with cardiopulmonary bypass are associated with a complexity of stress response leading to post-operative complications. Studies have confirmed that anesthesia can mitigate the surgically induced stress response. Objectives: The aim of this study was to compare the effects of propofol and isoflurane, both supplemented with Sufentanil, on the stress response in coronary artery bypass graft surgery with cardiopulmonary bypass, using cortisol as a biochemical marker. Methods: This double-blind randomized clinical trial was conducted on 72 patients who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass meeting the inclusion criteria. The subjects were randomly divided into two groups of isoflurane (n = 36) and propofol (n = 36) both supplemented with sufentanil. Serum cortisol levels were measured and compared between the groups; 30 minutes before the surgery (T0), at the end of the cardiopulmonary bypass (T1), and 24 hours after the surgery (T2). Results: Compared to the baseline (T0), at the end of cardiopulmonary bypass (T1), both groups demonstrated a decrease in plasma cortisol levels with no statistical significant difference (P = 0.4). At T2 measuring time point, the level of plasma cortisol significantly increased in both groups (P = 0.02), however this increase was less in the Isoflurane group. Conclusions: In CABG with cardiopulmonary bypass, using plasma cortisol level as a measure, Isoflurane-Sufentanil significantly reduces the stress response to the surgery, when compared to propofol-Sufentanil.
Postoperative Effects of Low-Dose Intrathecal Morphine in Coronary Artery Bypass Surgery
Journal of Cardiac Surgery, 2008
Background: Intrathecal morphine has been used in hopes of providing long-lasting postoperative analgesia in patients after cardiac surgery. The aim of this study was to evaluate the effects of 7 µ/kg intrathecal morphine administration in coronary bypass surgery in the postoperative period. Methods: We conducted a prospective, randomized, blinded, and controlled study. Twenty-three patients, who underwent primary elective coronary bypass surgery, were randomly allocated to receive morphine 7 µ/kg intrathecally, before the induction of general anesthesia (Group M, n = 12) or no intrathecal injection (Group C, n = 11). Pain scores, determined by visual analogue scale (VAS), were recorded immediately after extubation upon admission to the intensive care unit (ICU), at the 2nd, 4th, 6th, and 18th hour after extubation. Pethidine was administered if the patient's VAS ≥ 4 and consumption was recorded. Extubation time and ICU length of stay were also recorded. Results: VAS scores were lower in the Group M at each measured time than the control . According to the VAS scores, pethidine requirement was lower in the Group M than the control (p = 0.001). Extubation time (3.58 ± 1.57 vs. 4.86 ± 1.38 hours, p = 0.045) and ICU length of stay (16.25 ± 2.70 vs. 19.30 ± 2.45 hours, p = 0.014) were also significantly shorter in the Group M than the control group. No significant complications were seen in this group of patients. Conclusions: Intrathecal morphine provided effective analgesia, earlier tracheal extubation and less ICU length stay after on-pump coronary bypass surgery. The influence on ICU length of stay requires further evaluations.
Role of Anaesthetic Choice in Improving Outcome after Cardiac Surgery
Romanian Journal of Anaesthesia and Intensive Care, 2020
Clinical background Volatile anaesthetics (VAs) have been shown to protect cardiomyocytes against ischaemia and reperfusion injury in cardiac surgery. Clinical problems VAs have been shown in multiple trials and meta-analyses to be associated with better outcomes when compared to intravenous anaesthesia in cardiac surgery. However, recent data from a large randomised controlled trial do not confirm the superiority of VA as compared to total intravenous anaesthesia in this population. Review objectives This mini review presents the VA cardioprotective effects, their clinical use in cardiac surgery and the most recent evidence that compares VA to intravenous anaesthesia for reducing perioperative morbidity. At present, there is no clear superiority of VA over intravenous anaesthesia in improving the outcome after cardiac surgery.
Anaesthesia and Intensive Care, 1994
A randomized, controlled clinical trial was conducted on 72 patients undergoing elective cardiac surgery to compare patientcontrolled analgesia (PCA) to nurse-titrated infusion of morphine. Pain and nausea scores were assessed at 5, 20, 32 and 44 hours after cardiopulmonary bypass. Serum cortisol estimations were performed at 24 and 48 hours, and morphine consumption was measured at 0-24 and 24-48 hours. There was no difference between pain scores (P=0.72), nausea scores (P=0.52), serum cortisol at 24 and 48 hours (P=0.32 and P=0.34), and morphine consumption at 0-24 and 24-48 hours (P=0.16 and P=0.12). There was also no difference in the time to tracheal extubation (P= O. 79) and discharge from fCU (P= 0.64). There was a significant association between pain and serum cortisol at 48 hours (P= 0.023). This study also found a tenfold difference in the amount of morphine used (range = 11 to 108 mg), with no significant association with patient age or sex. We could find no significant benefit from the routine use of PCA in cardiac surgical patients.