Медицина неотложных состояний (Apr 2022)

Порівняльна характеристика ранніх ускладнень після аортокоронарного шунтування залежно від схеми анестезіологічного забезпечення

  • S.R. Maruniak

DOI
https://doi.org/10.22141/2224-0586.18.2.2022.1479
Journal volume & issue
Vol. 18, no. 2
pp. 80 – 86

Abstract

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Background. Despite a large number of publications on the influence of anesthesia components on the development of postoperative complications, the choice of the optimal anesthesia scheme during coronary artery bypass grafting (CABG) in patients with coronary heart disease remains unclear. The study was aimed to compare the effect of low-opioid and high-opioid anesthesia schemes on early clinical outcomes in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. Mate­rials and methods. The study included 120 patients who underwent CABG with cardiopulmonary bypass (CPB). The median operational risk for EuroSCORE II is 3.45 % (2.15 %; 4.05 %). Accor­ding to the scheme of anesthesia, all patients were divided into two groups: the first group (60 patients) — low-opioid scheme of anesthesia; the second group (60 patients) is a standard scheme of anes­thesia. Results. Patients in the first group were more than twice as likely to develop postoperative atrial fibrillation (POAF) compared with the second group (9 (15.0 %) vs. 19 (31.7 %), p = 0.031). In addition, patients in the first group were 2.3 times significantly less likely to have low cardiac output syndrome (LCOS) compared to the second group (11.7 % vs. 26.7 %, p = 0.037). The duration of CPB (p = 0.032) and the level of IL-6 after CPB (p = 0.004) were reliable indicators for predicting LCOS. The final statistical model [F (4, N = 120) = 12.52, p < 0.001, R2 = 0.304] covers almost a third of all factors in the development of LCOS. Only the level of IL-6 after CPB (the final statistical model [F (4, N = 120) = 11.54, p < 0.001, R2 = 0.286]) were reliable indicators for predicting POAF. Conclusions. The obtained results confirm the safety of clinical use of anesthesia schemes with low doses of opioids in cardiac surgery patients and emphasize the possibility of more conservative use of opioids in cardiac surgery.

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