From the Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France.
Department of Anaesthesiology and Intensive Care Medicine, University of Burgundy and Franche-Comté, Dijon, France.
Anesth Analg. 2023 May 1;136(5):965-974. doi: 10.1213/ANE.0000000000006383. Epub 2023 Feb 10.
There are no data on the effect of balanced nonopioid general anesthesia with lidocaine in cardiac surgery with cardiopulmonary bypass. The main study objective was to evaluate the association between nonopioid general balanced anesthesia and the postoperative complications in relation to opioid side effects.
Patients undergoing cardiac surgery with cardiopulmonary bypass between 2019 and 2021 were identified. After exclusion of patients for heart transplantation, left ventricular assistance device, and off-pump surgery, we classified patients according to an opioid general balanced anesthesia or a nonopioid balanced anesthesia with lidocaine. The primary outcome was a collapsed composite of postoperative complications that comprise respiratory failure and confusion, whereas secondary outcomes were acute renal injury, pneumoniae, death, intensive care unit (ICU), and hospital length of stay.
We identified 859 patients exposed to opioid-balanced general anesthesia with lidocaine and 913 patients exposed to nonopioid-balanced general anesthesia. Propensity score matching yielded 772 individuals in each group with balanced baseline covariates. Two hundred thirty-six patients (30.5%) of the nonopioid-balanced general anesthesia versus 186 patients (24.1%) presented postoperative composite complications. The balanced lidocaine nonopioid general anesthesia group was associated with a lower proportion with the postoperative complication composite outcome OR, 0.72 (95% CI, 0.58-0.92; P = .027). The number of patients with acute renal injury, death, and hospital length of stay did not differ between the 2 groups.
A balanced nonopioid general anesthesia protocol with lidocaine was associated with lower odds of postoperative complication composite outcome based on respiratory failure and confusion.
在体外循环心脏手术中，使用利多卡因的平衡非阿片类全麻的效果尚无数据。主要研究目的是评估非阿片类全麻平衡与阿片类药物副作用相关的术后并发症之间的关联。
确定了 2019 年至 2021 年期间接受体外循环心脏手术的患者。排除心脏移植、左心室辅助装置和非体外循环手术后，我们根据阿片类药物全麻平衡或含利多卡因的非阿片类全麻平衡对患者进行分类。主要结局是术后并发症的复合结局（包括呼吸衰竭和意识混乱），次要结局是急性肾损伤、肺炎、死亡、重症监护病房（ICU）和住院时间。
我们确定了 859 例接受阿片类药物平衡全麻加利多卡因的患者和 913 例接受非阿片类平衡全麻的患者。倾向评分匹配使每组有 772 例平衡基线协变量的个体。236 例（30.5%）非阿片类平衡全麻患者与 186 例（24.1%）患者出现术后复合并发症。非阿片类平衡全麻加利多卡因组术后复合并发症的比例较低，比值比为 0.72（95%置信区间，0.58-0.92；P=0.027）。两组间急性肾损伤、死亡和住院时间的患者数量无差异。
基于呼吸衰竭和意识混乱，含利多卡因的平衡非阿片类全麻方案与术后复合并发症结局的可能性较低相关。
