Multimodal low-opioid anesthesia as a factor in reducing the activation of the proinflammatory response in cardiac surgery

Abstract

The aim – to evaluate the effect of the low opioid anesthetic management scheme on the dynamics of cytokines (interleukin-6) during coronary artery bypass grafting (CABG). Materials and methods. The study included 120 patients with coronary heart disease who underwent CABG with application of 2-3 aortocoronary anastomoses under cardiopulmonary bypass. According to the anesthetic management, all patients were divided into two groups: the first group (n = 60) – low opioid multimodal anesthetic scheme; the second group (n = 60) – a standard scheme of anesthetic management. The determination of the level of interleukin-6 in the blood was carried out before and after the completion of cardiopulmonary bypass by enzyme-linked immunosorbent assay. Results. Conducting a low opioid multimodal and standard anesthetic management scheme was characterized by a relatively similar effect on the dynamics of systolic blood pressure and heart rate during CABG with cardiopulmonary bypass, except intubation stage, at which these indicators were significantly lower by 16.21 % (p = 0.001) and by 15.45 % (p = 0.001), respectively, in patients with a low opioid anesthetic management scheme. In patients with low opioid multimodal anesthesia, the level of interleukin-6 at the end of the surgery was by 25.61 % lower (p < 0.0001) compared to the results in patients with a standard scheme of anesthesia. Intraoperative use of red blood cell was characterized by a significant increase in interleukin-6 levels at the end of surgery. Conclusions. The use of a combination of ketamine, lidocaine and dexmedetomidine for multimodal low opioid anesthesia is characterized by relative safety, a sufficient level of analgesia and a low level of inflammatory response.

Keywords

• coronary artery bypass grafting
• cardiopulmonary bypass
• systemic inflammatory response syndrome