Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2024; 21 (3): 163-272 ➤ Мультимодальная анестезия кетамином и дексмедетомидином для ранней активизации больных после операции на сердце

Multimodal anesthesia via ketamin and dexmedetomidine promotes fast-track of a cardiac surgery patients

Authors: Rybka М.М., Diasamidze K.E., Yudin G.V., Khinchagov D.Ya., Mishin G.М., Chitorelidze М.А.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2024-21-3-252-263

UDC: 612.014.465:616.12-089.168

Link: Clinical Physiology of Blood Circulaiton. 2024; 21 (3): 252-263

Quote as: Rybka М.М., Diasamidze K.E., Yudin G.V., Khinchagov D.Ya., Mishin G.М., Chitorelidze М.А. Multimodal anesthesia via ketamin and dexmedetomidine promotes fast-track of a cardiac surgery patients. Clinical Physiology of Circulation. 2024; 21 (3): 252–263 (in Russ.). DOI: 10.24022/1814-6910-2024-21-3-252-263

Keywords:  fast-track cardiac surgery ketamine dexmedetomidine regional anesthesia extubation on the operating table

Received / Accepted:  07.08.2024 / 04.09.2024

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Abstract

Objective: to evaluate the efficacy and safety of multimodal anesthesia based on ketamine and dexmedetomidine as part of the approach to ultra-early activation of patients after open heart surgery.

Material and methods. 300 people were divided into two groups of 150 patients: the group of anesthesia based on ketamine and dexmedetomidine (Group I – KD) and the group of traditional anesthesia based on fentanyl and propofol (Group II – FP). The study points were hemodynamics, complication rate, extubation in the operating room, mortality, and quality of life.

Results. In the KD group, 64.7% of patients were extubated on the operating table (there was no reintubation). Various complications developed in 27.2% (n = 37) of patients in the KD group and in 31.9% (n = 45) of patients in the FP group (p = 0.39). There were no such patients in the AF group. We noted a decrease in heart rhythm (by 8.6%), AP (by 8.2%), an increase in shoke volume (by 7.5%) from the initial levels against the background of stabilization of cardiac index and peripheral vascular resistance in the absence of a decrease in oxygen delivery in the KD group. Hospital mortality was 2.2% (n = 3) in the KD group and 1.4% (n = 2) in the FP group (p = 0.62). Quality of life indicators did not differ statistically significantly between groups at all stages of the study.

Conclusion. The use of multimodal anesthesia based on ketamine and dexmedetomidine in patients during heart surgery is safe and effective, provides an “economical mode of operation” of the heart, ensures extubation on the operating table. The choice of anesthesia method does not statistically significantly affect the quality of life of patients.

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****
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About Authors

  • Mikhail M. Rybka, Dr. Med. Sci., Deputy Director for Anesthesiology and Resuscitation, Head of the Department of Anesthesiology, Resuscitation and Intensive Care; ORCID
  • Kakhaber E. Diasamidze, Dr. Med. Sci., Leading Researcher; ORCID
  • Gennadiy V. Yudin, Dr. Med. Sci., Head of the Department of Resuscitation and Intensive Care № 3; ORCID
  • Dzhumber Ya. Khinchagov, Head of the Anesthesiology and Resuscitation Department № 2; ORCID
  • Georgiy M. Mishin, Postgraduate; ORCID
  • Mariam A. Chitorelidze, Postgraduate; ORCID

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