Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC881110.15690/vramn8811CARDIOLOGY AND CARDIOVASCULAR SURGERY: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ КАРДИОЛОГИИ И СЕРДЕЧНО-СОСУДИСТОЙ ХИРУРГИИResearch ArticleEvolution and Perspectives of Anesthesia and Analgesia Techniques for Coronary Artery Bypass GraftingЭволюция и перспективы анестезии и методов обезболивания при коронарном шунтированииhttps://orcid.org/0000-0002-5138-3617ParomovKonstantin V.ПаромовКонстантин Валентинович
Russian Federation

MD, PhD

к.м.н.

kp-82@mail.ruhttps://orcid.org/0000-0001-5798-9209SvirskiiDmitii A.СвирскийДмитрий Алексеевич
Russian Federation

MD, PhD

к.м.н.

dsvirskiy@mail.ruhttps://orcid.org/0000-0002-4375-3374KirovMikhail Yu.КировМихаил Юрьевич
Russian Federation

MD, PhD, Professor, Corresponding Member of the RAS

д.м.н., профессор, член-корреспондент РАН

mikhail_kirov@hotmail.ruVolosevich First City Clinical HospitalПервая городская клиническая больница им. Е.Е. ВолосевичNorthern State Medical UniversityСеверный государственный медицинский университет231220237865415482504202301122023Copyright ©; 2023, "Paediatrician" Publishers LLCCopyright ©; 2023, Издательство "Педиатръ"2023"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/8811

For more than 60-year history of coronary artery bypass grafting, surgical techniques and specialists’ competence were improved as well as the safety of anesthesiological management. This analytical review discusses modern features of analgesia during coronary surgery and early postoperative period. We described current opinion on perioperative administration of opioids and modern methods of analgesia, taking into account possible complications of their use. Despite the low mortality and overall safety of coronary bypass grafting nowadays, the optimal strategy of analgesia for this surgery is not established yet. This review lists routinely used analgetics and some aspects of their use in cardiac anesthesiology, outlines trends and prospects for the introduction of new drugs and techniques for analgesia. Despite a number of restrictions on the use of opioids in intensive care in modern era, in cardiac anesthesiology their use remains justified and, under certain conditions, safe enough.

За 60-летнюю историю коронарного шунтирования изменилась хирургическая техника, возросли компетенции специалистов и, без-условно, повысилась безопасность анестезиологического сопровождения. В данном аналитическом обзоре обсуждаются современные особенности обезболивания в ходе коронарного шунтирования и в раннем послеоперационном периоде. Приведена эволюция взглядов на использование опиоидов, описаны современные методы анальгезии с учетом возможных осложнений их использования. Несмотря на низкую летальность и достаточную безопасность операции коронарного шунтирования в настоящее время, оптимальная стратегия обезболивания при данном вмешательстве остается предметом дискуссий. В обзоре перечислены традиционные анальгетики и особенности их применения в кардиоанестезиологии, обозначены тенденции и перспективы внедрения новых препаратов и методик для анальгезии. Несмотря на ряд ограничений к использованию опиоидов в современной медицине критических состояний, в кардиоанестезиологии их применение остается оправданным и при соблюдении определенных условий — достаточно безопасным.

analgesic agentsanesthesiasternotomycoronary artery bypass surgeryАнальгетикианестезиястернотомиякоронарное шунтированиеMcNichols B, Spratt JR, George J, et al. Coronary Artery Bypass: Review of Surgical Techniques and Impact on Long-Term Revascularization Outcomes. Cardiol Ther. 2021;10(1):89–109. doi: https://doi.org/10.1007/s40119-021-00211-zБокерия Л.А., Милиевская Е.Б., Прянишников В.В., Юрлов И.А. Сердчно-сосудистая хирургия – 2022. Болезни и врожденные аномалии системы кровообращения. — М.: НМИЦ им. А.Н. Бакулева Минздрава России, 2023. — 344 с. [Bokeriya LA, Milievskaya EB, Pryanishnikov VV, YUrlov IA. Serdchno-sosudistaya hirurgiya – 2022. Bolezni i vrozhdennye anomalii sistemy krovoobrashcheniya. Moscow: NMIC im. A.N. Bakuleva Minzdrava Rossii; 2023. 344 s. (In Russ.)]Rong LQ, Kamel MK, Rahouma M, et al. High-dose versus low-dose opioid anesthesia in adult cardiac surgery: A meta-analysis. J Clin Anesth. 2019;57:57–62. doi: https://doi.org/10.1016/j.jclinane.2019.03.009White PF. Propofol: its role in changing the practice of anesthesia. Anesthesiology. 2008;109(6):1132–1136. doi: https://doi.org/10.1097/ALN.0b013e31818ddba8Kotani Y, Pruna A, Turi S, et al. Propofol and survival: an updated meta-analysis of randomized clinical trials. Crit Care. 2023;27(1):139. doi: https://doi.org/10.1186/s13054-023-04431-8Kelz MB, Mashour GA. The Biology of General Anesthesia from Paramecium to Primate. Curr Biol. 2019;29(22):1199–1210. doi: https://doi.org/10.1016/j.cub.2019.09.071Guerrero-Orriach JL, Carmona-Luque MD, Gonzalez-Alvarez L. Heart Failure after Cardiac Surgery: The Role of Halogenated Agents, Myocardial Conditioning and Oxidative Stress. Int J Mol Sci. 2022;23(3):1360. doi: https://doi.org/10.3390/ijms23031360Ranjan R, Adhikary D, Rahman M, et al. Fast Tract Anesthesia Using Isoflurane and Propofol During Off-pump Coronary Artery Bypass Graft Surgery. Mymensingh Med J. 2019;28(4):811–818.Yiğit Özay H, Demir A, Balci E, et al. The effects of total intravenous and inhalation anesthesia maintenance on tissue oxygenation in coronary artery bypass graft surgery. Eur Rev Med Pharmacol Sci. 2022;26(12):4279–4288. doi: https://doi.org/10.26355/eurrev_202206_29066Fodale V, Santamaria LB, Schifilliti D, et al. Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism mimicking Alzheimer’s disease. Anaesthesia. 2010;65(4):388–395. doi: https://doi.org/10.1111/j.1365-2044.2010.06244.xMertes PM, Kindo M, Amour J, et al. Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump. Anaesth Crit Care Pain Med. 2022;41(3):101059. doi: https://doi.org/10.1016/j.accpm.2022.101059Pezzella AT. Global aspects of cardiothoracic surgery with focus on developing countries. Asian Cardiovasc Thorac Ann. 2010;18(3):299–310. doi: https://doi.org/10.1177/0218492310370060.Tam DY, Nedadur R, Yu M, et al. Rigid plate fixation versus wire cerclage for sternotomy after cardiac surgery: a meta-analysis. Ann Thorac Surg. 2018;106(1):298–304. doi: https://doi.org/10.1016/j.athoracsur.2018.02.043Kowalewski M, Pawliszak W, Malvindi PG, et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis. J Thorac Cardiovasc Surg. 2016;151(1):60–77. doi: https://doi.org/10.1016/j.jtcvs.2015.08.042Machado RJ, Saraiva FA, Mancio J, et al. A systematic review and meta-analysis of randomized controlled studies comparing off-pump versus on-pump coronary artery bypass grafting in the elderly. J Cardiovasc Surg (Torino). 2022;63(1):60–68. doi: https://doi.org/10.23736/S0021-9509.21.12012-9Xu Y, Li Y, Bao W, et al. MIDCAB versus off-pump CABG: Comparative study. Hellenic J Cardiol. 2020;61(2):120–124. doi: https://doi.org/10.1016/j.hjc.2018.12.004Florisson DS, DeBono JA, Davies RA, et al. Does minimally invasive coronary artery bypass improve outcomes compared to off-pump coronary bypass via sternotomy in patients undergoing coronary artery bypass grafting? Interact Cardiovasc Thorac Surg. 2018;27(3):357–364. doi: https://doi.org/10.1093/icvts/ivy071Wong WT, Lai VK, Chee YE, et al. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev. 2016;9(9):CD003587. doi: https://doi.org/10.1002/14651858Williams JB, McConnell G, Allender JE, et al. One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program. J Thorac Cardiovasc Surg. 2019;157(5):1881–1888. doi: https://doi.org/10.1016/j.jtcvs.2018.10.164Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations. JAMA Surg. 2019;154(8):755–766. doi: https://doi.org/10.1001/jamasurg.2019.1153Овечкин А.М., Баялиева А.Ж., Ежевская А.А., и др. Послеоперационное обезболивание. Клинические рекомендации // Вестник интенсивной терапии им. А.И. Салтанова. — 2019. — № 4. — С. 9–33. [Ovechkin AM, Bayalieva AZh, Ezhevskaya AA, et al. Postoperative analgesia. Guidelines. Annals of Critical Care. 2019;4:9–33. (In Russ.)]. doi: https://doi.org/10.21320/1818-474X-2019-4-9-33Milgrom LB, Brooks JA, Qi R, et al. Pain levels experienced with activities after cardiac surgery. Am J Crit Care. 2004;13(2):116–125.Mori M, Brooks C 2nd, Dhruva SS, et al. Trajectories of Pain After Cardiac Surgery: Implications for Measurement, Reporting, and Individualized Treatment. Circ Cardiovasc Qual Outcomes. 2021;14(8):e007781. doi: https://doi.org/10.1161/CIRCOUTCOMES.120.007781Bjørnnes AK, Parry M, Lie I, et al. Pain experiences of men and women after cardiac surgery. J Clin Nurs. 2016;25(19–20):3058–3068. doi: https://doi.org/10.1111/jocn.13329Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet. 2019;393(10180):1537–1546. doi: https://doi.org/10.1016/S0140-6736(19)30352-6Gerbershagen HJ, Aduckathil S, van Wijck AJ, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934–944. doi: https://doi.org/10.1097/ALN.0b013e31828866b3Benhamou D, Berti M, Brodner G, et al. Postoperative Analgesic THerapy Observational Survey (PATHOS): a practice pattern study in 7 central/southern European countries. Pain. 2008;136(1–2):134–141. doi: https://doi.org/10.1016/j.pain.2007.06.028Polomano RC, Dunwoody CJ, Krenzischek DA, et al. Perspective on pain management in the 21st century. Pain Manag Nurs. 2008;9(1 Suppl):S3–10. doi: https://doi.org/10.1016/j.pmn.2007.11.002Katijjahbe MA, Royse C, Granger C, et al. Location and Patterns of Persistent Pain Following Cardiac Surgery. Heart Lung Circ. 2021;30(8):1232–1243. doi: https://doi.org/10.1016/j.hlc.2020.12.009Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514–517, e202-5.Lavand’homme P, Steyaert A. Opioid-free anesthesia opioid side effects: Tolerance and hyperalgesia. Best Pract Res Clin Anaesthesiol. 2017;31(4):487–498. doi: https://doi.org/10.1016/j.bpa.2017.05.003Harrogate SR, Cooper JA, Zawadka M, et al. Seven-year follow-up of persistent postsurgical pain in cardiac surgery patients: A prospective observational study of prevalence and risk factors. Eur J Pain. 2021;25(8):1829–1838. doi: https://doi.org/10.1002/ejp.1794Allen KB, Brovman EY, Chhatriwalla AK, et al. Opioid-Related Adverse Events: Incidence and Impact in Patients Undergoing Cardiac Surgery. Semin Cardiothorac Vasc Anesth. 2020;24(3):219–226. doi: https://doi.org/10.1177/1089253219888658Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287–2298. doi: https://doi.org/10.2147/JPR.S144066Shanthanna H, Ladha KS, Kehlet H, et al. Perioperative Opioid Administration. Anesthesiology. 2021;134(4):645–659. doi: https://doi.org/10.1097/ALN.0000000000003572Altun D, Çınar Ö, Özker E, et al. The effect of tramadol plus paracetamol on consumption of morphine after coronary artery bypass grafting. J Clin Anesth. 2016;36:189–193. doi: https://doi.org/10.1016/j.jclinane.2016.10.030Radbruch L, Glaeske G, Grond S, et al. Topical Review on the Abuse and Misuse Potential of Tramadol and Tilidine in Germany. Subst Abus. 2013;34(3):313–320. doi: https://doi.org/10.1080/08897077.2012.735216Iyer S, Mohan G, Ramakrishnan S, et al. Comparison of tapentadol with tramadol for analgesia after cardiac surgery. Ann Card Anaesth. 2015;18(3):352. doi: https://doi.org/10.4103/0971-9784.159805Ayoub SS. Paracetamol (acetaminophen): A familiar drug with an unexplained mechanism of action. Temperature (Austin). 2021;8(4):351–371. doi: https://doi.org/10.1080/23328940.2021.1886392Subramaniam B, Shankar P, Shaefi S, et al. Effect of Intravenous Acetaminophen vs Placebo Combined with Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. JAMA. 2019;321(7):686–696. doi: https://doi.org/10.1001/jama.2019.0234Schjerning A-M, McGettigan P, Gislason G. Cardiovascular effects and safety of (non-aspirin) NSAIDs. Nat Rev Cardiol. 2020;17(9):574–584. doi: https://doi.org/10.1038/s41569-020-0366-zNussmeier NA, Whelton AA, Brown MT, et al. Complications of the COX-2 Inhibitors Parecoxib and Valdecoxib after Cardiac Surgery. N Engl J Med. 2005:352(11):1081–1091. doi: https://doi.org/10.1056/nejmoa050330Arora M, Choudhary S, Singh PK, et al. Structural investigation on the selective COX-2 inhibitors mediated cardiotoxicity: A review. Life Sci. 2020;251:117631. doi: https://doi.org/10.1016/j.lfs.2020.117631Peng PW, Wijeysundera DN, Li CC. Use of gabapentin for perioperative pain control — a meta-analysis. Pain Res Manag. 2007;12(2):85–92. doi: https://doi.org/10.1155/2007/840572Maitra S, Baidya DK, Bhattacharjee S, et al. Perioperative gabapentin and pregabalin in cardiac surgery: a systematic review and meta-analysis. Rev Bras Anesthesiol. 2017;67(3):294–304. doi: https://doi.org/10.1016/j.bjan.2016.07.005Grape S, Kirkham KR, Frauenknecht J, et al. Intra‐operative analgesia with remifentanil vs. dexmedetomidine: a systematic review and meta‐analysis with trial sequential analysis. Anaesthesia. 2019;74(6):793–800. doi: https://doi.org/10.1111/anae.14657Xiao M, Jiang CF, Gao Q, et al. Effect of Dexmedetomidine on Cardiac Surgery Patients. J Cardiovasc Pharmacol. 2023;81(2):104–113. doi: https://doi.org/10.1097/FJC.0000000000001384Mazzeffi M, Johnson K, Paciullo C. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: an evidence-based clinical review. Ann Card Anaesth. 2015;18(2):202–209. doi: https://doi.org/10.4103/0971-9784.154478Meco M, Giustiniano E, Cecconi M, et al. Pharmacological prevention of postoperative delirium in patients undergoing cardiac surgery: a bayesian network meta-analysis. J Anesth. 2023;37(2):294–310. doi: https://doi.org/10.1007/s00540-023-03170-yDaykin H. The efficacy and safety of intravenous lidocaine for analgesia in the older adult: a literature review. Br J Pain. 2017;11(1):23–31. doi: https://doi.org/10.1177/2049463716676205Devarajan J, Balasubramanian S, Shariat AN, et al. Regional Analgesia for Cardiac Surgery. Part 2: Peripheral Regional Analgesia for Cardiac Surgery. Semin Cardiothorac Vasc Anesth. 2021;25(4):265–279. doi: https://doi.org/10.1177/10892532211002382Rasmussen LS, Johnson T, Kuipers HM, et al. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand. 2003;47(3):260–266. doi: https://doi.org/10.1034/j.1399-6576.2003.00057.xAmour J, Cholley B, Ouattara A, et al. The effect of local anesthetic continuous wound infusion for the prevention of postoperative pneumonia after on-pump cardiac surgery with sternotomy: the STERNOCAT randomized clinical trial. Intensive Care Med. 2019;45(1):33–43. doi: https://doi.org/10.1007/s00134-018-5497-xПаромов К.В., Свирский Д.А., Киров М.Ю. Регионарные методики в практике кардиоанестезиолога: есть ли выбор? // Анестезиология и реаниматология. — 2021. — № 6. — С. 75–81. [Paromov KV, Svirskii DA, Kirov MYu. Regional anesthesia in cardiac surgery: is there a choice? Russian Journal of Anaesthesiology and Reanimatology. 2021;6:75–81. (In Russ.)] doi: https://doi.org/10.17116/anaesthesiology202106175Guay J, Kopp S. Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. Cochrane Database Syst Rev. 2019;3(3):CD006715. doi: https://doi.org/10.1002/14651858.cd006715.pub3Sandeep B, Huang X, Li Y, et al. A comparison of regional anesthesia techniques in patients undergoing video-assisted thoracic surgery: A network meta-analysis. Int J Surg. 2022;105:106840. doi: https://doi.org/10.1016/j.ijsu.2022.106840Yeung JH, Gates S, Naidu BV, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2(2):CD009121. doi: https://doi.org/10.1002/14651858.CD009121.pub2Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57. doi: https://doi.org/10.1016/j.jpain.2015.12.008Castroman P, Quiroga O, Mayoral Rojals V, et al. Reimagining How We Treat Acute Pain: A Narrative Review. Cureus. 2022;14(4):e23992. doi: https://doi.org/10.7759/cureus.23992