Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump

Mertès, Paul-Michel; Kindo, Michel; Amour, Julien; Baufreton, Christophe; Camilleri, Lionel; Caus, Thierry; Chatel, Didier; Cholley, Bernard; Curtil, Alain; Grimaud, Jean-Philippe; Houel, Rémi; Kattou, Fehmi; Guidon, C.; Guinot, Pierre‐Grégoire; Lebreton, Guillaume; Marguerite, Sandrine; Ouattara, Alexandre; Fruithiot, Sophie Provenchère; Rozec, Bertrand; Verhoye, Jean‐Philippe; Vincentelli, André; Charbonneau, Hélène

doi:10.1016/j.accpm.2022.101059

Cited by 52 publications

(17 citation statements)

References 273 publications

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“…Notably, our study focused on modern cardiac care, where physicians employ proactive hemodynamic strategies and optimize cardiovascular states ( Patel et al, 2020 ), potentially mitigating perioperative risks associated with ACE inhibitor maintenance. These strategies are part of enhanced recovery after surgery (ERAS) programs and are widely recommended ( Mertes et al, 2022 ). These results, therefore, corroborate a previous pilot randomized controlled trial conducted by van Diepen et al (2018) .…”

Section: Discussionmentioning

confidence: 99%

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

Guilleminot,

Andrei,

Nguyen

et al. 2024

Front. Pharmacol.

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Objective: We investigated the effects of the maintenance of angiotensin-converting enzyme inhibitors (ACE inhibitors) the day of the surgery on the incidence of postoperative acute kidney injury (AKI) and cardiac events in patients undergoing cardiac surgery.Methods: We performed a multicentric observational study with propensity matching on 1,072 patients treated with ACE inhibitors. We collected their baseline demographic data, comorbidities, and operative and postoperative outcomes. AKI was defined by KDIGO (Kidney Disease: Improving Global Outcome).Results: Maintenance of an ACE inhibitor was not associated with an increased risk of AKI (OR: 1.215 (CI95%:0.657–2.24), p = 0.843, 71 patients (25.1%) vs. 68 patients (24%)). Multivariate logistic regression and sensitive analysis did not demonstrate any association between ACE inhibitor maintenance and AKI, following cardiac surgery (OR: 1.03 (CI95%:0.81–1.3)). No statistically significant difference occurs in terms of incidence of cardiogenic shock (OR: 1.315 (CI95%:0.620–2.786)), stroke (OR: 3.313 (CI95%:0.356–27.523)), vasoplegia (OR: 0.741 (CI95%:0.419–1.319)), postoperative atrial fibrillation (OR: 1.710 (CI95%:0.936–3.122)), or mortality (OR: 2.989 (CI95%:0.343–26.034)). ICU and hospital length of stays did not differ (3 [2; 5] vs. 3 [2; 5] days, p = 0.963 and 9.5 [8; 12] vs. 10 [8; 14] days, p = 0.638).Conclusion: Our study revealed that maintenance of ACE inhibitors on the day of the surgery was not associated with increased postoperative AKI. ACE inhibitor maintenance was also not associated with an increased rate of postoperative major cardiovascular events (arterial hypotension, cardiogenic shock, vasopressors use, stroke and death).

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Section: Discussionmentioning

confidence: 99%

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

Guilleminot,

Andrei,

Nguyen

et al. 2024

Front. Pharmacol.

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“…In this way, recent guidelines support such an approach. 5 Another point to be discussed is the place of this type of anesthesia in the framework of an early perioperative rehabilitation program. 36 It is likely that the observed effects could be smaller with such practices.…”

Section: Discussionmentioning

confidence: 99%

“…4 Based on the literature, it has been suggested that avoiding opioid use may be associated with better outcomes. 5 However, the clinical benefit for postoperative pulmonary complications is less certain. Two small retrospective studies have demonstrated some clinical benefits in relation to the use of nonopioid drugs.…”

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confidence: 99%

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

Guinot

Andrei

Durand

et al. 2023

Anesthesia &Amp; Analgesia

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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.

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“…Patients who train pre-operatively for a period of at least 4 weeks have seen reductions in post-operative pulmonary complications such as severe pneumopathy and atelectasis as well as a decreased length of hospital stay. [ 11 ] Exercise represents an intervention that increases functional capacity, improves health status, decreases sympathetic over-reactivity, and improves insulin sensitivity and may be associated to an overall improved psychological readiness for surgery. A comprehensive pre-habilitation program should also be joined with nutrition optimization (N), exercise training (E), and anxiety reduction (W for worry; such intervention is referred as a ‘NEW’ approach).…”

Section: Pre-operative Interventionsmentioning

confidence: 99%

Enhanced recovery after cardiac surgery: A literature review

Navas-Blanco,

Kantola,

Whitton

et al. 2024

Saudi Journal of Anaesthesia

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Enhanced recovery after cardiac surgery (ERACS) represents a constellation of evidence-based peri-operative methods aimed to reduce the physiological and psychological stress patients experience after cardiac surgery, with the primary objective of providing an expedited recovery to pre-operative functional status. The method involves pre-operative, intra-operative, and post-operative interventions as well as direct patient engagement to be successful. Numerous publications in regard to the benefits of enhanced recovery have been presented, including decreased post-operative complications, shortened length of stay, decreased overall healthcare costs, and higher patient satisfaction. Implementing an ERACS program undeniably requires a culture change, a methodical shift in the approach of these patients that ultimately allows the team to achieve the aforementioned goals; therefore, team-building, planning, and anticipation of obstacles should be expected.

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Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump

Cited by 52 publications

References 273 publications

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

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

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

Enhanced recovery after cardiac surgery: A literature review

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