Original research

DOI: http://doi.org/10.31928/2305-3127-2019.4.2128 

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

S.R. Maruniak 1, 2, O.A. Loskutov 1, 2, O.M. Druzhyna 1, 2, I.R. Malysh 1, 3, V.G. Kolesnikov 1, 2, N.O. Korotchuk 2 

1 Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
2 Heart Institute, Ministry of Health of Ukraine, Kyiv, Ukraine
3 Kyiv City Clinical Hospital for Emergency Medical Care, Kyiv, Ukraine

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.

Key words: coronary artery bypass grafting, cardiopulmonary bypass, systemic inflammatory response syndrome.

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