eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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3/2020
vol. 17
 
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abstract:
Original paper

The use of multimodal low-opioid anesthesia for coronary artery bypass grafting surgery in conditions of artificial blood circulation

Oleg Loskutov
1
,
Taisiia Danchyna
1
,
Dmitryi Dzuba
1
,
Oleksandr Druzina
2

  1. Department of Anesthesiology and Intensive Care, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
  2. Department of Anaesthesiology and Perfusiology, SE “Heart Institute” of MOH, Kyiv, Ukraine
Kardiochir Torakochir Pol 2020; 17 (3): 111-116
Online publish date: 2020/09/23
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Introduction
Cardiovascular diseases (CVD) are the main cause of death worldwide, and according to experts, they will continue to dominate the structure of global mortality.

Aim
The effectiveness of the multimodal low-opioid anesthesia technique in performing coronary artery bypass graft operations with artificial blood circulation.

Material and methods
Ninety-six patients aged 61.8 ±10.4 years underwent coronary artery bypass grafting under artificial blood circulation. Group I: propofol, sevoflurane, fentanyl, pipecuronium bromide (standard doses). Group II: dexketoprofen trometamol (50 mg), intravenous lidocaine (1% – 1 mg/kg bolus) and continuous lidocaine infusion (1.5–2 mg/kg/h), propofol, ketamine (0.5 mg/kg), magnesia sulfate, minimal doses of fentanyl.

Results
Average duration of anesthesia – 257.4 ±19.1 min; assisted blood circulation – 55 ±10 min. Mean dose of fentanyl in group I – 4.66 ±1.58 µg/kg/h, in group II – 1.29 ±0.32 µg/kg/h.Standard lab values and stress hormonal changes were within the normal range (mean cortisol: 479.3 ±26.4 nmol/l, lactate 1.61 ±0.2 mmol/l, glucose 6.42 ±0.9 mmol/l). Changes in heart rate within group I had a significant amplitude of dynamics, while in group II, these values were relatively at the same level throughout the entire anesthetic provision. Mean arterial pressure changes in group I were characterized by a significant reduction at the stage of induction, support and sternum reduction, whereas in group II it was relatively at the same level during the entire anesthetic management and significantly differed from baseline only at the stage of induction.

Conclusions
Multimodal low-opioid anesthesia during coronary artery bypass surgery with artificial blood circulation allows one to ensure adequate analgesia and avoid the intraoperative usage of routine doses of fentanyl, as indicated by the absence of hemodynamic and endocrine-metabolic changes.

keywords:

anesthesia, cardiac, intravenous lidocaine, opioid-free, low-opioid

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