McClain Megan Rose, Subramaniam Kathirvel, Cheema Roshni, Lavage Danielle R, Lin Hsing-Hua Sylvia, Sultan Ibrahim, Sadhasivam Senthilkumar, Howard-Quijano Kimberly
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.
J Cardiothorac Vasc Anesth. 2025 Feb;39(2):406-413. doi: 10.1053/j.jvca.2024.11.012. Epub 2024 Nov 16.
To evaluate the effect of intraoperative intravenous methadone within a standardized enhanced recovery after cardiac surgery pathway on the perioperative corrected QT interval (QTc).
Retrospective cohort study.
Cardiac surgical patients from a tertiary academic medical institution.
Eligible 1,040 adult patients undergoing elective cardiac surgery from July 2020 through July 2023 using validated institutional electronic medical record data INTERVENTIONS: Patients were administered intravenous methadone (0.1 mg/kg) or received analgesics other than intravenous methadone as part of an enhanced recovery after cardiac surgery pathway.
The primary outcomes were change in QTc and the percent QTc change between preoperative QTc and postoperative QTc upon intensive care unit admission. Secondary outcomes include postoperative ventricular arrhythmias, postoperative atrial fibrillation, intensive care unit length of stay, 30-day mortality, 1-year mortality, and mortality days from surgery. Out of a total of 1,040 patients, 423 received intraoperative methadone and 617 did not receive methadone. Methadone QTc mixed models demonstrated that QTc is prolonged immediately postoperatively and normalized 24 hours after surgery in both methadone and nonmethadone groups. There were no significant differences in baseline QTc, immediate postoperative QTc, changes in QTc, or percent change in QTc between the methadone and nonmethadone groups. There were no significant differences in ventricular or atrial arrhythmias, 30-day mortality, 1-year mortality, or days to death.
A single intraoperative intravenous methadone dose did not prolong the QTc significantly or increase the incidence of arrhythmias and may be safe in adult cardiac surgical patients.
评估在标准化心脏手术后强化康复路径中术中静脉注射美沙酮对围手术期校正QT间期（QTc）的影响。
回顾性队列研究。
一家三级学术医疗机构的心脏外科患者。
使用经过验证的机构电子病历数据，选取2020年7月至2023年7月期间接受择期心脏手术的1040例成年患者。
作为心脏手术后强化康复路径的一部分，患者接受静脉注射美沙酮（0.1mg/kg）或接受除静脉注射美沙酮以外的其他镇痛药。
主要结局是QTc的变化以及重症监护病房入院时术前QTc与术后QTc之间的QTc变化百分比。次要结局包括术后室性心律失常、术后心房颤动、重症监护病房住院时间、30天死亡率、1年死亡率以及术后死亡天数。在总共1040例患者中，423例接受了术中美沙酮治疗，617例未接受美沙酮治疗。美沙酮QTc混合模型表明，美沙酮组和非美沙酮组术后QTc均立即延长，并在术后24小时恢复正常。美沙酮组和非美沙酮组在基线QTc、术后即刻QTc、QTc变化或QTc变化百分比方面无显著差异。在室性或房性心律失常、30天死亡率、1年死亡率或死亡天数方面也无显著差异。
单次术中静脉注射美沙酮剂量不会显著延长QTc或增加心律失常的发生率，对成年心脏手术患者可能是安全的。
