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

• Published in: Journal of cardiothoracic surgery 2023-10, Vol.18 (1), p.1-272, Article 272
• Main Authors: Stepan, Maruniak, Oleh, Loskutov, Oleksandr, Druzhyna, Justyna, Swol
• Format: Article
• Language: English
• Subjects: Analysis; Anesthesia; Anticoagulants; Atrial fibrillation; Blood pressure; Bypass; Cardiac arrhythmia; Cardiac output; Cardiac patients; Cardiopulmonary bypass; Cardiovascular disease; Cardiovascular diseases; Cohort analysis; Complications; Coronary artery bypass; Coronary artery bypass grafting; Coronary artery disease; Coronary heart disease; Coronary vessels; Data collection; Dexmedetomidine; Drug dosages; Ejection fraction; Electrocardiography; Fentanyl; Fibrillation; Gases; Grafting; Heart diseases; Heart rate; Heart surgery; Hemodynamics; Hemoglobin; Hospitals; Hypothermia; IL-6; Interleukin 6; Intubation; Low cardiac output syndrome; Mechanical ventilation; Medical research; Medicine, Experimental; Mortality; Multimodal low-opioid anesthesia protocol; Narcotics; Opioids; Patients; Postoperative; Postoperative atrial fibrillation; Postoperative period; Surgery; Ventilation; Ventilators
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-023-02395-y

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 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 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 [+ or -] 9.4 vs. 44.9 [+ or -] 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 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 The study is registered in clinicaltrials.gov âNCT05514652. Keywords: Coronary artery bypass grafting, Cardiopulmonary bypass, Multimodal low-opioid anesthesia protocol, IL-6, Low cardiac output syndrome, Postoperative atrial fibrillation