Monitored Anesthesia Care <i>Versus</i> Intubated General Anesthesia for Open Heart Surgery Under Cardiopulmonary Bypass: A Prospective Cohort Study

Abstract

Background: Though Cardiac surgery under cardiopulmonary bypass (CPB) under epidural anesthesia in conscious patients is associated with increased risk of epidural hematoma. We developed a monitored anesthesia care (MAC) platform for cardiac surgery under CPB. In the current prospective study, we investigated the safety and effectiveness of the MAC platform versus intubated general anesthesia (IGA) in patients receiving elective open-heart surgery. Methods: The study included adult patients who were scheduled to undergo open-heart surgery under CPB at our hospital between April 2012 and February 2017. MAC consisted of local anesthesia at the site of sternotomy, sedation with dexmedetomidine, analgesia with remifentanil/sufentanil, and electroacupuncture. MAC versus IGA was chosen by the patients. Findings: Eleven patients received MAC and 13 patients received IGA. The two groups were comparable in the demographic, baseline and operative variables. No conversion occurred from MAC to IGA. No major complications occurred during the surgery in both groups. No confirmed awareness events after surgery were reported in both groups. There was no statistical difference in the incidence of postoperative complications between the two groups (P >0.05). The intraoperative consumption of sufentanil and remifentanil was significantly lower in the MAC group than the IGA group (P < 0.001). The time to drinking was significantly shorter in the MAC group (2.14±0.90 h) than the IGA group (22.31±3.33 h) (P <0.001). Furthermore, the length of ICU stay was significantly shorter in the MAC group (7.09±3.11 d) than the IGA group (14.46±0.66 d) (P <0.001). The intraoperative and 24 and 48-h vasoactive-inotropic score was significantly lower in the MAC group than the IGA group (P < 0.001). Moreover, significantly more patients would recommend anesthesia to others in the MAC group than the IGA group (11/11 vs. 9/13, P =0.044). Interpretations: MAC is safe for cardiac surgery under CPB and promotes postoperative recovery. Funding Statement: None. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study protocol was approved by the local Ethics Committee (#2012-191-07-01). All patients provided written informed consent for the study.