From the Guidelines
Recent advances in cardiac anesthesia prioritize enhanced recovery after surgery (ERAS) protocols, which include multimodal analgesia, reduced perioperative fasting, and early rehabilitation, as evidenced by the 2022 guidelines on enhanced recovery after cardiac surgery 1. These protocols aim to improve patient satisfaction and reduce postoperative morbidity and mortality. Key components of ERAS protocols include:
- Multimodal analgesia with opium-free anesthesia
- Reduced perioperative fasting period
- Early rehabilitation
- Patient information and education
The use of nonopioid medications, such as acetaminophen, ketamine, and dexmedetomidine, as part of a multimodal analgesic approach, has been shown to reduce perioperative opioid use in cardiac surgery 1. Additionally, goal-directed therapy, which targets specific hemodynamic goals, has yielded inconsistent results and requires further investigation to determine its use in cardiac surgery 1. Intraoperative transesophageal echocardiography (TEE) has been shown to aid in real-time assessment of heart valve function and pathology, as well as hemodynamic status, regional wall motion, ventricular function, valve anatomy, and diastolic function 1.
The implementation of ERAS protocols, combined with advancements in monitoring technologies, pharmacological agents, and procedural techniques, has collectively improved patient outcomes by providing more precise control of hemodynamics, reducing inflammatory responses, enabling earlier extubation, and facilitating enhanced recovery after cardiac surgery 1. Some of the key monitoring technologies and pharmacological agents used in cardiac anesthesia include:
- Enhanced echocardiography capabilities, such as 3D transesophageal echocardiography
- Short-acting agents like remifentanil, dexmedetomidine, and clevidipine
- Goal-directed fluid therapy using stroke volume variation
- Point-of-care coagulation testing with thromboelastography (TEG) or rotational thromboelastometry (ROTEM)
Overall, the recent advances in cardiac anesthesia prioritize a multimodal approach to patient care, focusing on enhanced recovery, reduced morbidity and mortality, and improved patient outcomes.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recent Advances in Cardiac Anesthesia
- The use of opioid-free anesthesia (OFA) strategies, such as dexmedetomidine and lidocaine, is being explored to limit adverse effects associated with opioids in cardiac surgery 2.
- Dexmedetomidine has been shown to be an effective postoperative sedative without clear advantages over midazolam or propofol in cardiac surgery patients 3.
- The safety and efficacy of dexmedetomidine for sedation in cardiac surgery intensive care units have been demonstrated, with reduced incidence of bradycardia and hypotension 3.
Multimodal Analgesic Regimens
- Multimodal analgesic regimens, including dexmedetomidine and methadone, have been shown to reduce total and predischarge opioid use in cardiac surgical patients 4.
- These regimens have also been associated with reduced pain scores and postoperative nausea and vomiting (PONV) treatment 4.
Comparison of Sedatives
- Dexmedetomidine has been compared to morphine-based therapy after cardiac surgery, with reduced duration of delirium and less hypotension, but more bradycardia 5.
- The use of dexmedetomidine has also been associated with earlier extubation and reduced vasopressor requirement compared to morphine regimen 5.
Opioid-Free Anesthesia
- The OFA strategy using dexmedetomidine and lidocaine may reduce the incidence of major opioid-related complications after cardiac surgery, including postoperative cognitive disorder, postoperative ileus, acute respiratory distress, and death 2.
- Further research is needed to fully understand the benefits and limitations of OFA strategies in cardiac anesthesia 2.