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The association between Enhanced Recovery After Cardiac Surgery (ERACS) guided analgesics and postoperative delirium

Published:January 08, 2023DOI:https://doi.org/10.1053/j.jvca.2022.12.023

      Abstract

      Objectives

      Delirium is a common postoperative complication associated with death and long-term cognitive impairment. We studied the association between opioid-sparing anesthetics incorporating Enhanced Recovery After Cardiac Surgery (ERACS) guided analgesics and postoperative delirium.

      Design

      We performed a retrospective review of non-emergent coronary, valve, or ascending aorta surgery patients.

      Setting

      A tertiary academic medical institution.

      Participants

      We analyzed a dataset of elective adult cardiac surgical patients. All patients ≥18 years undergoing elective cardiac surgery from 11/2/2017 until 2/2/21 were eligible for inclusion.

      Interventions

      The ERACS-guided multimodal pain regimen included preoperative oral acetaminophen and gabapentin, and intraoperative intravenous lidocaine, ketamine, and dexmedetomidine.

      Measurements and Main Results

      Delirium was measured by bedside nurses using Confusion Assessment Method for ICU (CAM-ICU). Delirium occurred in 220 of the 1,675 patients (13.7%). Use of any component of the multimodal pain regimen was not associated with delirium (Odds Ratio: 0.85 [95% confidence interval: 0.63, 1.16]). Individually, acetaminophen was associated with reduced odds of delirium (OR: 0.60 [95% CI: 0.37, 0.95]). Gabapentin (OR: 1.36 [95% CI: 0.97, 2.21]), lidocaine (OR: 0.86 [95% CI: 0.53, 1.37]), ketamine (OR: 1.15 [95% CI: 0.72, 1.83]), and dexmedetomidine (OR: 0.79 [95% CI: 0.46, 1.31]) were not individually associated with postoperative delirium. Individual ERACS elements were associated with secondary outcomes hospital length of stay, ICU duration, postoperative opioid administration, and postoperative intubation duration.

      Conclusions

      Use of an opioid sparing perioperative ERACS pain regimen was not associated with reduced postoperative delirium, opioid consumption, or additional poor outcomes. Individually, acetaminophen was associated with reduced delirium.

      Keywords

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