Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 of Zhangheng Road, Pudong New Area, Shanghai, 201203, China.
Acupuncture and Anesthesia Research Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
Eur J Med Res. 2024 Oct 19;29(1):504. doi: 10.1186/s40001-024-02078-x.
The aim of this study is to assess the feasibility and safety of monitored anesthesia care (MAC) versus intubated general anesthesia (IGA) for patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).
This prospective observational study included patients scheduled for cardiac surgery involving CPB at our institution between April 2012 and February 2017. The enrolled patients were categorized into MAC and IGA groups. MAC involved local anesthesia at the sternotomy site, sedation with dexmedetomidine, analgesia with remifentanil/sufentanil, and electroacupuncture (EA). Eleven patients underwent MAC, and 13 patients received IGA. There were no instances of conversion from MAC to IGA, and both groups exhibited no major complications. The demographic characteristics, baseline parameters, and operative variables were comparable between the two groups.
Intraoperative opioid consumption was significantly lower in the MAC group compared to the IGA group (P < 0.001). The time to oral intake of liquids was significantly shorter in the MAC group (2.14 ± 0.90 h) compared to the IGA group (22.31 ± 3.33 h) (P < 0.001). Furthermore, the intensive care unit length of stay (ICU-LOS) and perioperative vasoactive-inotropic score (VIS) were significantly reduced in the MAC group compared to the IGA group (P < 0.001).
MAC emerges as a safe and viable alternative to general anesthesia for specific patient groups undergoing cardiac surgery with CPB. Furthermore, it may enhance postoperative recovery and minimize postoperative complications compared to IGA.
本研究旨在评估在体外循环（CPB）下接受择期心脏手术的患者采用监测麻醉管理（MAC）与气管内全身麻醉（IGA）的可行性和安全性。
本前瞻性观察性研究纳入了 2012 年 4 月至 2017 年 2 月期间在我院接受 CPB 心脏手术的患者。纳入的患者被分为 MAC 和 IGA 组。MAC 组采用胸骨切开术局部麻醉、右美托咪定镇静、瑞芬太尼/舒芬太尼镇痛和电针（EA）。11 例患者采用 MAC，13 例患者采用 IGA。没有从 MAC 转为 IGA 的病例，两组均无重大并发症。两组的人口统计学特征、基线参数和手术变量均无显著差异。
MAC 组术中阿片类药物的消耗量明显低于 IGA 组（P < 0.001）。MAC 组的液体口服摄入时间明显短于 IGA 组（2.14 ± 0.90 h 比 22.31 ± 3.33 h）（P < 0.001）。此外，MAC 组的重症监护病房住院时间（ICU-LOS）和围术期血管活性药物指数（VIS）明显低于 IGA 组（P < 0.001）。
MAC 作为一种安全可行的替代方案，适用于特定的 CPB 下接受心脏手术的患者群体。与 IGA 相比，MAC 可能会促进术后恢复并减少术后并发症。
