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Abstract：
BACKGROUND: An optimal pharmacological strategy for fast-track cardiac anesthesia (FTCA) is unclear. This study evaluated the effectiveness and safety of an FTCA program using methadone and non-opioid adjuvant infusions (magnesium, ketamine, lidocaine, and dexmedetomidine) in patients undergoing coronary artery bypass grafting.
METHODS: This retrospective, multicenter observational study was conducted across private and public teaching sectors. We studied patients managed by a fast-track protocol or via usual care according to clinician preference. The primary outcome was the total mechanical ventilation time in hours adjusted for hospital, body mass index, category of surgical urgency, cardiopulmonary bypass time and EuroSCORE II. Secondary outcomes included successful extubation within four postoperative hours, postoperative pain scores, postoperative opioid requirements, and the development of postoperative complications.
RESULTS: We included 87 patients in the fast-track group and 88 patients in the usual care group. Fast-track patients had a 35% reduction in total ventilation hours compared with usual care patients (p = 0.007). Thirty-five (40.2%) fast-track patients were extubated within four hours compared to 10 (11.4%) usual-care patients (odds ratio: 5.2 [95% CI: 2.39-11.08; p < 0.001]). Over 24 h, fast-track patients had less severe pain (p < 0.001) and required less intravenous morphine equivalent (22.00 mg [15.75:32.50] vs. 38.75 mg [20.50:81.75]; p < 0.001). There were no significant differences observed in postoperative complications or length of hospital stay between the groups.
CONCLUSIONS: Implementing an FTCA protocol using methadone, dexmedetomidine, magnesium, ketamine, lignocaine, and remifentanil together with protocolized weaning from a mechanical ventilation protocol is associated with significantly reduced time to tracheal extubation, improved postoperative analgesia, and reduced opioid use without any adverse safety events. A prospective randomized trial is warranted to further investigate the combined effects of these medications in reducing complications and length of stay in FTCA.
BACKGROUND: The study protocol was registered in the Australian New Zealand Clinical Trials Registry ( https://www.anzctr.org.au/ACTRN12623000060640.aspx , retrospectively registered on 17/01/2023).
METHODS: This retrospective, multicenter observational study was conducted across private and public teaching sectors. We studied patients managed by a fast-track protocol or via usual care according to clinician preference. The primary outcome was the total mechanical ventilation time in hours adjusted for hospital, body mass index, category of surgical urgency, cardiopulmonary bypass time and EuroSCORE II. Secondary outcomes included successful extubation within four postoperative hours, postoperative pain scores, postoperative opioid requirements, and the development of postoperative complications.
RESULTS: We included 87 patients in the fast-track group and 88 patients in the usual care group. Fast-track patients had a 35% reduction in total ventilation hours compared with usual care patients (p = 0.007). Thirty-five (40.2%) fast-track patients were extubated within four hours compared to 10 (11.4%) usual-care patients (odds ratio: 5.2 [95% CI: 2.39-11.08; p < 0.001]). Over 24 h, fast-track patients had less severe pain (p < 0.001) and required less intravenous morphine equivalent (22.00 mg [15.75:32.50] vs. 38.75 mg [20.50:81.75]; p < 0.001). There were no significant differences observed in postoperative complications or length of hospital stay between the groups.
CONCLUSIONS: Implementing an FTCA protocol using methadone, dexmedetomidine, magnesium, ketamine, lignocaine, and remifentanil together with protocolized weaning from a mechanical ventilation protocol is associated with significantly reduced time to tracheal extubation, improved postoperative analgesia, and reduced opioid use without any adverse safety events. A prospective randomized trial is warranted to further investigate the combined effects of these medications in reducing complications and length of stay in FTCA.
BACKGROUND: The study protocol was registered in the Australian New Zealand Clinical Trials Registry ( https://www.anzctr.org.au/ACTRN12623000060640.aspx , retrospectively registered on 17/01/2023).
摘要：
背景：快速心脏麻醉（FTCA）的最佳药理学策略尚不清楚。本研究评估了使用美沙酮和非阿片类药物佐剂输注的FTCA计划的有效性和安全性（镁，氯胺酮,利多卡因,和右美托咪定）用于接受冠状动脉旁路移植术的患者。
方法：本回顾性研究，在私人和公共教学部门进行了多中心观察研究。我们根据临床医生的喜好，研究了通过快速通道协议或常规护理管理的患者。主要结果是根据医院调整的总机械通气时间（以小时为单位），身体质量指数,外科急迫的类别，体外循环时间和EuroSCOREII。次要结果包括术后4小时内成功拔管，术后疼痛评分,术后阿片类药物需求，以及术后并发症的发展。
结果：我们纳入了87例快速治疗组患者和88例常规治疗组患者。与常规护理患者相比，快速跟踪患者的总通气时间减少了35％（p=0.007）。与10例（11.4%）常规治疗患者相比，35例（40.2%）快速治疗患者在4小时内拔管（比值比：5.2[95%CI：2.39-11.08；p<0.001]）。超过24小时，快速治疗患者的疼痛较轻（p<0.001），需要的静脉注射吗啡当量较少（22.00mg[15.75:32.50]vs.38.75mg[20.50:81.75];p<0.001)。两组之间的术后并发症或住院时间没有显着差异。
结论：使用美沙酮实施FTCA方案，右美托咪定,镁，氯胺酮,利多卡因,瑞芬太尼与机械通气协议中的脱乳油一起与气管拔管时间显着缩短有关，改善术后镇痛，减少阿片类药物的使用，没有任何不良安全事件。有必要进行前瞻性随机试验，以进一步研究这些药物在减少FTCA并发症和住院时间方面的综合作用。
背景：该研究方案已在澳大利亚新西兰临床试验注册中心注册（https://www.anzctr.org.au/ACTRN12623000060640。aspx,于2023年1月17日追溯注册)。
方法：本回顾性研究，在私人和公共教学部门进行了多中心观察研究。我们根据临床医生的喜好，研究了通过快速通道协议或常规护理管理的患者。主要结果是根据医院调整的总机械通气时间（以小时为单位），身体质量指数,外科急迫的类别，体外循环时间和EuroSCOREII。次要结果包括术后4小时内成功拔管，术后疼痛评分,术后阿片类药物需求，以及术后并发症的发展。
结果：我们纳入了87例快速治疗组患者和88例常规治疗组患者。与常规护理患者相比，快速跟踪患者的总通气时间减少了35％（p=0.007）。与10例（11.4%）常规治疗患者相比，35例（40.2%）快速治疗患者在4小时内拔管（比值比：5.2[95%CI：2.39-11.08；p<0.001]）。超过24小时，快速治疗患者的疼痛较轻（p<0.001），需要的静脉注射吗啡当量较少（22.00mg[15.75:32.50]vs.38.75mg[20.50:81.75];p<0.001)。两组之间的术后并发症或住院时间没有显着差异。
结论：使用美沙酮实施FTCA方案，右美托咪定,镁，氯胺酮,利多卡因,瑞芬太尼与机械通气协议中的脱乳油一起与气管拔管时间显着缩短有关，改善术后镇痛，减少阿片类药物的使用，没有任何不良安全事件。有必要进行前瞻性随机试验，以进一步研究这些药物在减少FTCA并发症和住院时间方面的综合作用。
背景：该研究方案已在澳大利亚新西兰临床试验注册中心注册（https://www.anzctr.org.au/ACTRN12623000060640。aspx,于2023年1月17日追溯注册)。
