Balanced Nonopioid General Anesthesia With Lidocaine Is Associated With Lower Postoperative Complications Compared With Balanced Opioid General Anesthesia With Sufentanil for Cardiac Surgery With Cardiopulmonary Bypass: A Propensity Matched Cohort Study

Abstract

BACKGROUND: There are no data on the effect of balanced nonopioid general anesthesia with lidocaine in cardiac surgery with cardiopulmonary bypass. The main study objective was to evaluate the association between nonopioid general balanced anesthesia and the postoperative complications in relation to opioid side effects. METHODS: Patients undergoing cardiac surgery with cardiopulmonary bypass between 2019 and 2021 were identified. After exclusion of patients for heart transplantation, left ventricular assistance device, and off-pump surgery, we classified patients according to an opioid general balanced anesthesia or a nonopioid balanced anesthesia with lidocaine. The primary outcome was a collapsed composite of postoperative complications that comprise respiratory failure and confusion, whereas secondary outcomes were acute renal injury, pneumoniae, death, intensive care unit (ICU), and hospital length of stay. RESULTS: We identified 859 patients exposed to opioid-balanced general anesthesia with lidocaine and 913 patients exposed to nonopioid-balanced general anesthesia. Propensity score matching yielded 772 individuals in each group with balanced baseline covariates. Two hundred thirty-six patients (30.5%) of the nonopioid-balanced general anesthesia versus 186 patients (24.1%) presented postoperative composite complications. The balanced lidocaine nonopioid general anesthesia group was associated with a lower proportion with the postoperative complication composite outcome OR, 0.72 (95% CI, 0.58–0.92; P = .027). The number of patients with acute renal injury, death, and hospital length of stay did not differ between the 2 groups. CONCLUSIONS: A balanced nonopioid general anesthesia protocol with lidocaine was associated with lower odds of postoperative complication composite outcome based on respiratory failure and confusion.

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

“…Although our study challenges the routine withholding of ACE inhibitors, interpreting these findings requires caution. The rapidly evolving landscape of cardiac surgery, encompassing advancements in monitoring, surgical techniques, cardioplegia, and anesthesia, may influence postoperative outcomes ( Guinot et al, 2019 ; 2023a ). Future studies should consider the impact of postoperative reintroduction timing of ACE inhibitors, possibly in conjunction with other medications like beta-blockers, to reconcile the variability observed across the published literature.…”

In Response

“…In Response W e have received with great consideration the correspondence by Ordies and Rex 1 regarding our article. 2 We extend our gratitude to the authors for their constructive comments. We agree with the authors about the inherent limitations in using a composite end point.…”

Balanced Nonopioid General Anesthesia With Lidocaine Is Associated With Lower Postoperative Complications Compared With Balanced Opioid General Anesthesia With Sufentanil for Cardiac Surgery With Cardiopulmonary Bypass

“…We have read with great interest the original research report by Guinot et al 1 published in Anesthesia & Analgesia .…”

“…First, the primary outcome of this study was a composite end point, according to the authors based on typical side effects of opioid care, that is, a combination of the postoperative need for ventilation (both invasive and noninvasive), and the incidences of postoperative reintubation, acute respiratory distress syndrome (ARDS), and confusion. 1 The authors refer to the Postoperative and Opioid-Free Anesthesia (POFA) trial, but in that study, the primary outcome was a composite of hypoxemia (Sp o 2 level of <95%), postoperative ileus, and postoperative cognitive dysfunction. 3 Ventilatory failure, reintubation, and development of ARDS were not considered.…”

“…In Response W e thank Jefferies et al 1 for their correspondence related to our systematic review and meta-analysis. 2 The benefits of high-flow nasal cannula (HFNC) in prolonging safe apnea time for induction of anesthesia have been demonstrated in nonobese patients, 3 but it is not clear if this benefit is observed in patients with obesity.…”