Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland.
Department of Cardiac Surgery, Lausanne University Hospital, 1005 Lausanne, Switzerland.
Medicina (Kaunas). 2024 Jun 25;60(7):1036. doi: 10.3390/medicina60071036.
: Dexmedetomidine, an alpha-2 agonist, is used as an adjunct to anesthesia in enhanced recovery after surgery (ERAS) programs. One of its advantages is the opioid-sparing effect which can facilitate early extubation and recovery. When the ERAS cardiac society was set in 2017, our facility was already using the ERAS program, in which the "fast-track Anesthesia" was facilitated by the intraoperative infusion of dexmedetomidine. Our objective is to share our experience and investigate the potential impact of intraoperative dexmedetomidine use as a part of the ERAS program on patient outcomes in elective cardiac surgery. : An observational retrospective cohort study was conducted at a university hospital in Switzerland. The patients who underwent elective cardiac surgery with cardiopulmonary bypass between 1 June 2017 and 31 August 2018 were included in this analysis ( = 327). Regardless of the surgery type, all the patients received a standardized fast-track anesthesia protocol inclusive of dexmedetomidine infusion, reduced opioid dose, and parasternal nerve block. The primary outcome was the postoperative time when the criteria for extubation were met. Three groups were identified: group 0-(extubated in the operating room), group < 6 (extubated in less than 6 h), and group > 6 (extubated in >6 h). The secondary outcomes were adverse events, length of stay in ICU and in hospital, and total hospitalization costs. : Dexmedetomidine was well-tolerated, with no significant adverse events reported. Early extubation was performed in 187 patients (57%). Group 3 had a significantly longer length of stay in the ICU (median: 70 h vs. 25 h) and in hospital (17 vs. 12 days), and consequently higher total hospitalization costs (CHF 62,551 vs. 38,433) compared to the net data from the other two groups ( < 0.0001). : Our findings suggest that dexmedetomidine can be safely used as part of the opioid-sparing anesthesia protocol in patients undergoing elective cardiac surgery with cardiopulmonary bypass with the potential to facilitate early extubation, shorter ICU and hospital stays, and reduced hospitalization costs.
: 右美托咪定是一种 α-2 激动剂，在术后加速康复 (ERAS) 方案中被用作辅助麻醉。它的一个优点是具有阿片类药物节约效应，可以促进早期拔管和恢复。当 2017 年成立 ERAS 心脏学会时，我们的机构已经在使用 ERAS 方案，该方案通过术中输注右美托咪定来促进“快速通道麻醉”。我们的目的是分享我们的经验，并研究术中使用右美托咪定作为 ERAS 方案的一部分对择期心脏手术患者结局的潜在影响。 : 在瑞士的一所大学医院进行了一项观察性回顾性队列研究。这项分析纳入了 2017 年 6 月 1 日至 2018 年 8 月 31 日期间接受体外循环择期心脏手术的患者（n=327）。无论手术类型如何，所有患者均接受标准化的快速通道麻醉方案，包括右美托咪定输注、减少阿片类药物剂量和胸大肌神经阻滞。主要结局是符合拔管标准的术后时间。将患者分为三组：组 0（在手术室拔管）、组 < 6（6 小时内拔管）和组 > 6（6 小时后拔管）。次要结局为不良事件、重症监护病房和住院时间以及总住院费用。 : 右美托咪定耐受性良好，无明显不良反应报告。187 名患者（57%）进行了早期拔管。组 3 在重症监护病房（中位数：70 小时比 25 小时）和住院（17 天比 12 天）的停留时间明显更长，因此总住院费用（瑞士法郎 62551 比 38433）也更高，与其他两组的数据相比有显著差异（<0.0001）。 : 我们的研究结果表明，右美托咪定可安全用于体外循环择期心脏手术患者的阿片类药物节约麻醉方案中，具有促进早期拔管、缩短重症监护病房和住院时间以及降低住院费用的潜力。
