Jannati Mansour, Attar Armin
Department of Cardiovascular Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Ther Clin Risk Manag. 2019 Jun 20;15:773-781. doi: 10.2147/TCRM.S195267. eCollection 2019.
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.
本综述旨在研究冠状动脉旁路移植术（CABG）后镇痛和镇静在疼痛管理、辅助呼吸、术后整体医疗护理及住院方面的作用。数据收集自PubMed、Scopus和Cochrane数据库。搜索使用了以下术语：“镇痛”“镇静”“冠状动脉旁路移植术”“CABG”及“阿片类药物”。对1988年至2018年间的文章进行了评估。在各类胸外科手术尤其是CABG手术中，几种用于缓解手术疼痛的阿片类和非阿片类镇痛药被视为引发肺部和心血管并发症的关键危险因素。CABG术后患者的有效疼痛管理很大程度上取决于有效的疼痛评估、所使用镇静剂和镇痛药的类型以及对其镇痛效果的评估。一个重大挑战是确定CABG术后患者合适的镇痛药和镇静剂用量，因为患者常常会要求使用超出所需量的镇静剂和镇痛药。当患者术后感觉舒适且无负面副作用时，疼痛管理过程即被视为成功。然而，术后疼痛管理模式尚未纳入许多现代方法，如患者自控镇痛，且术后疼痛管理药物仍局限于有限种类的阿片类和非阿片类镇痛药。
