Department of Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, China.
The Third Central Clinical College, Tianjin Medical University, Tianjin, China.
Basic Clin Pharmacol Toxicol. 2024 Aug;135(2):180-194. doi: 10.1111/bcpt.14043. Epub 2024 Jun 21.
Various postoperative sedation protocols with different anaesthetics lead to profound effects on the outcomes for post-cardiac surgery patients. However, a comprehensive analysis of optimal postoperative sedation strategies for patients in the intensive care unit (ICU) after cardiac surgery is lacking.
We systematically searched for randomized controlled trials (RCTs) in databases including PubMed and Embase. The primary outcome measured the duration of mechanical ventilation (MV) in the ICU, and the secondary outcome encompassed the length of stay (LOS) in the ICU and hospital and the monitoring adverse events.
The literature included 18 RCTs (1652 patients) with 13 sedation regimens. Dexmedetomidine plus ketamine and sevoflurane were associated with a significantly reduced duration of MV when compared with propofol. Our results also suggested that dexmedetomidine plus ketamine may associated with a shorter LOS in ICU, and sevoflurane associated with a shorter LOS in the hospital, respectively.
The combination of dexmedetomidine and ketamine seems to be a better option for adult patients needing sedation after cardiac surgery, and the incidence of side effects is lower with dexmedetomidine. These findings have potential implications for medication management in the perioperative pharmacotherapy of cardiac surgery patients.
不同的术后镇静方案与不同的麻醉剂相结合，对心脏手术后患者的结果有深远影响。然而，对于心脏手术后 ICU 患者的最佳术后镇静策略，缺乏全面的分析。
我们系统地在包括 PubMed 和 Embase 在内的数据库中搜索了随机对照试验（RCT）。主要结局指标是 ICU 中机械通气（MV）的持续时间，次要结局指标包括 ICU 和医院的停留时间（LOS）以及监测不良事件。
文献包括 18 项 RCT（1652 名患者），其中有 13 种镇静方案。与丙泊酚相比，右美托咪定加氯胺酮和七氟醚与 MV 持续时间明显缩短相关。我们的结果还表明，右美托咪定加氯胺酮可能与 ICU 中 LOS 缩短有关，而七氟醚与医院中 LOS 缩短有关。
右美托咪定联合氯胺酮似乎是心脏手术后需要镇静的成年患者的更好选择，并且右美托咪定的副作用发生率较低。这些发现对心脏手术患者围手术期药物治疗中的药物管理具有潜在意义。
