• Pierre-Grégoire Guinot, Stefan Andrei, Bastien Durand, Audrey Martin, Valerian Duclos, Alexandra Spitz, Vivien Berthoud, Tiberiu Constandache, Sandrine Grosjean, Mohamed Radhouani, Jean-Baptiste Anciaux, Maxime Nguyen, and Belaid Bouhemad.
• From the Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France.
• Anesth. Analg. 2023 May 1; 136 (5): 965974965-974.

BackgroundThere are no data on the effect of balanced nonopioid general anesthesia with lidocaine in cardiac surgery with cardiopulmonary bypass. The main study objective was to evaluate the association between nonopioid general balanced anesthesia and the postoperative complications in relation to opioid side effects.MethodsPatients undergoing cardiac surgery with cardiopulmonary bypass between 2019 and 2021 were identified. After exclusion of patients for heart transplantation, left ventricular assistance device, and off-pump surgery, we classified patients according to an opioid general balanced anesthesia or a nonopioid balanced anesthesia with lidocaine. The primary outcome was a collapsed composite of postoperative complications that comprise respiratory failure and confusion, whereas secondary outcomes were acute renal injury, pneumoniae, death, intensive care unit (ICU), and hospital length of stay.ResultsWe identified 859 patients exposed to opioid-balanced general anesthesia with lidocaine and 913 patients exposed to nonopioid-balanced general anesthesia. Propensity score matching yielded 772 individuals in each group with balanced baseline covariates. Two hundred thirty-six patients (30.5%) of the nonopioid-balanced general anesthesia versus 186 patients (24.1%) presented postoperative composite complications. The balanced lidocaine nonopioid general anesthesia group was associated with a lower proportion with the postoperative complication composite outcome OR, 0.72 (95% CI, 0.58-0.92; P = .027). The number of patients with acute renal injury, death, and hospital length of stay did not differ between the 2 groups.ConclusionsA balanced nonopioid general anesthesia protocol with lidocaine was associated with lower odds of postoperative complication composite outcome based on respiratory failure and confusion.Copyright © 2023 International Anesthesia Research Society.

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