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Higher intraoperative opioid doses in cardiac surgery were linked to reduced postoperative opioid needs. This study highlights variability in opioid administration practices among anesthesiologists, emphasizing the need for clear dose distinctions.

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Area of Science:

  • Anesthesiology
  • Cardiovascular Surgery
  • Pharmacology

Background:

  • High-dose opioid use in cardiac anesthesia is controversial due to potential postoperative complications.
  • Variability exists in intraoperative opioid administration among cardiac anesthesiologists.

Purpose of the Study:

  • To compare postoperative opioid consumption based on intraoperative opioid doses (low, moderate, high) in adult cardiac surgery patients.
  • To examine the association between intraoperative opioid dose categories and postoperative opioid consumption.
  • To investigate variability in intraoperative opioid use among anesthesiologists.

Main Methods:

  • Retrospective cohort study of 6390 adult cardiac surgery patients (2014-2022).
  • Patients categorized into lower (LOR), mid (MOR), or higher (HOR) opioid recipients based on intraoperative morphine milligram equivalents (MME).
  • Multivariable models assessed the association between intraoperative opioid dose group and postoperative opioid consumption (MME and MME/kg).

Main Results:

  • Higher intraoperative opioid recipients (HOR) showed significantly less postoperative opioid consumption compared to LOR and MOR groups (P < 0.001 for all comparisons).
  • Mean Ratio (MR) for MME was 0.51 (0.47, 0.56) for HOR vs LOR and 0.53 (0.50, 0.57) for HOR vs MOR.
  • Mean Ratio (MR) for MME/kg was 0.51 (0.48, 0.55) for HOR vs LOR and 0.55 (0.51, 0.58) for HOR vs MOR.
  • Significant variability in intraoperative opioid administration was observed among anesthesiologists.

Conclusions:

  • Higher intraoperative opioid doses are associated with lower postoperative opioid consumption in elective adult cardiac surgery.
  • The findings underscore the need for clearer definitions and distinctions between high and low opioid dose techniques in cardiac anesthesia.
  • Addressing variability in opioid administration is crucial for optimizing patient care and outcomes.