Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, NY, NY, USA.
Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, NY, NY, USA.
J Clin Anesth. 2019 Nov;57:57-62. doi: 10.1016/j.jclinane.2019.03.009. Epub 2019 Mar 11.
We performed a systematic comparison of high-dose and low-dose opioid anesthesia in cardiac surgery.
Systematic review and meta-analysis of randomized controlled trials (RCTs).
Operating room.
1400 adult patients undergoing cardiac surgery using general anesthesia.
All RCTs comparing the effects of various doses of intravenous opioids (morphine, fentanyl, sufentanil, and remifentanil) during adult cardiac surgery using general anesthesia published until May 2018 (full-text English articles reporting data from human subjects) were included.
Primary outcome was intensive care unit (ICU) length of stay (LOS). Secondary outcomes were ventilation time, use of vasopressors, perioperative myocardial infarction, perioperative stroke, and hospital LOS.
Eighteen articles were included (1400 patients). There was no difference in ICU LOS between studies using high or low dose of opioids (both short-acting and long-acting) (standard mean difference [SMD]-0.02, 95%CI: -0.15-0.11, P = 0.74). Similarly, there was no difference in secondary outcomes of ventilation time (SMD-0.27, 95%CI: -0.63-0.09, P = 0.14), use of vasopressors (OR 0.61, 95%CI: 0.29-1.30, P = 0.20), myocardial infarction (risk difference 0.00, 95% CI: -0.02-0.03, P = 0.70), stroke (RD 0.00, 95% CI: -0.01-0.01, P = 0.92) and hospital LOS (SMD 0.03, 95% CI: -0.26-0.33, P = 0.84). At meta-regression, there was no effect of age, gender, or type of opioid on the difference between groups.
Our data suggest that low-dose opioids, both short acting and long acting, are safe and effective to use in adult cardiac surgery patients, independent of the clinical characteristics of the patients and the type of opioid used. In view of the current opioid epidemic, low-dose opioid anesthesia should be considered for cardiac surgery patients.
我们对心脏手术中的高剂量和低剂量阿片类麻醉进行了系统比较。
随机对照试验（RCT）的系统评价和荟萃分析。
手术室。
1400 名接受全身麻醉的心脏手术的成年患者。
纳入所有比较成人心脏手术中不同剂量静脉内阿片类药物（吗啡、芬太尼、舒芬太尼和瑞芬太尼）作用的 RCT（直至 2018 年 5 月发表的全文为英文的报告人体数据的文章）。
主要结局为重症监护病房（ICU）入住时间（ LOS）。次要结局为通气时间、血管加压药使用、围手术期心肌梗死、围手术期卒中和住院 LOS。
纳入 18 篇文章（1400 例患者）。使用高剂量或低剂量阿片类药物（短效和长效）的研究在 ICU LOS 方面无差异（均数差[SMD]-0.02，95%CI：-0.15-0.11，P=0.74）。同样，通气时间（SMD-0.27，95%CI：-0.63-0.09，P=0.14）、血管加压药使用（OR 0.61，95%CI：0.29-1.30，P=0.20）、心肌梗死（风险差异 0.00，95%CI：-0.02-0.03，P=0.70）、卒中和住院 LOS（SMD 0.03，95%CI：-0.26-0.33，P=0.84）的次要结局也无差异。在荟萃回归中，年龄、性别或阿片类药物类型对组间差异无影响。
我们的数据表明，无论是短效还是长效阿片类药物，低剂量阿片类药物在成人心脏手术患者中安全有效，与患者的临床特征和使用的阿片类药物类型无关。鉴于当前的阿片类药物流行，心脏手术患者应考虑使用低剂量阿片类药物麻醉。
