Cargando…
Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery
BACKGROUNDS: Hyperlactatemia is a common metabolic disorder after cardiac surgery with cardiopulmonary bypass. Epinephrine use has been identified as a potential cause of increased lactate levels after cardiac surgery. Stress can lead to an increase in catecholamines, mainly epinephrine, in the body...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9461198/ https://www.ncbi.nlm.nih.gov/pubmed/36085208 http://dx.doi.org/10.1186/s13019-022-01986-5 |
_version_ | 1784786924772261888 |
---|---|
author | Zhan, Yu-Fei Shi, Quan Pan, Yu-Chen Zheng, Bao-Shi Ge, Yi-Peng Luo, Tian-Ge Xiao, Zhi-Hong Jiang, Wei |
author_facet | Zhan, Yu-Fei Shi, Quan Pan, Yu-Chen Zheng, Bao-Shi Ge, Yi-Peng Luo, Tian-Ge Xiao, Zhi-Hong Jiang, Wei |
author_sort | Zhan, Yu-Fei |
collection | PubMed |
description | BACKGROUNDS: Hyperlactatemia is a common metabolic disorder after cardiac surgery with cardiopulmonary bypass. Epinephrine use has been identified as a potential cause of increased lactate levels after cardiac surgery. Stress can lead to an increase in catecholamines, mainly epinephrine, in the body. Exogenous epinephrine causes hyperlactatemia, whereas endogenous epinephrine released by stress may have the same effect. Opioids are the most effective anesthetics to suppress the stress response in the body. The authors sought to provide evidence through a retrospective data analysis that helps investigate the relationship between intraoperative opioid dosage and postoperative lactic acidosis after cardiac surgery. METHODS: The clinical data of 215 patients who underwent valvular heart surgery with cardiopulmonary bypass from July 2016 to July 2019 were analyzed retrospectively. Blood lactate levels were measured at 0.1 h, 2 h, 4 h, and 8 h after surgery. Patients with continuous increases in lactate levels and lactate levels exceeding 5 mmol/L at two or more time points were included in the lactic acidosis group, whereas the other patients were included in the control group. First, univariate correlation analysis was used to identify parameters that were significantly different between the two groups, and then multivariate regression analysis was conducted to elucidate the independent risk factors for lactic acidosis. Fifty-one pairs of patients were screened by propensity score matching analysis (PSM). Then, lactic acid levels at four time points in both groups were analyzed by repeated measures ANOVA. RESULTS: he EF (heart ejection fraction) (OR = 0.94, P = 0.003), aortic occlusion time (OR = 10.17, P < 0.001) and relative infusion rate (OR = 2.23, P = 0.01) of sufentanil was an independent risk factor for lactic acidosis after valvular heart surgery. The patients were further divided into two groups with the mean sufentanil infusion rate as the reference point. The data were filtered with PSM (Propensity Score Matching). Lactic acid values in both groups peaked at 4 h after surgery and then declined. The rate of lactic acid decline was significantly faster in the group with a higher sufentanil dosage than in the lower group. The difference was statistically significant (P < 0.05). There was also a significant difference in lactic acid levels at the four time points (0.1 h, 2 h, 4 h and 8 h after surgery) in both groups (P < 0.001). CONCLUSION: The inadequate intraoperative infusion rate of sufentanil is an independent risk factor for lactic acidosis after heart valve surgery. The possibility of lactic acidosis caused by this factor after cardiac surgery should be considered, which is helpful for postoperative patient management. |
format | Online Article Text |
id | pubmed-9461198 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-94611982022-09-10 Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery Zhan, Yu-Fei Shi, Quan Pan, Yu-Chen Zheng, Bao-Shi Ge, Yi-Peng Luo, Tian-Ge Xiao, Zhi-Hong Jiang, Wei J Cardiothorac Surg Research BACKGROUNDS: Hyperlactatemia is a common metabolic disorder after cardiac surgery with cardiopulmonary bypass. Epinephrine use has been identified as a potential cause of increased lactate levels after cardiac surgery. Stress can lead to an increase in catecholamines, mainly epinephrine, in the body. Exogenous epinephrine causes hyperlactatemia, whereas endogenous epinephrine released by stress may have the same effect. Opioids are the most effective anesthetics to suppress the stress response in the body. The authors sought to provide evidence through a retrospective data analysis that helps investigate the relationship between intraoperative opioid dosage and postoperative lactic acidosis after cardiac surgery. METHODS: The clinical data of 215 patients who underwent valvular heart surgery with cardiopulmonary bypass from July 2016 to July 2019 were analyzed retrospectively. Blood lactate levels were measured at 0.1 h, 2 h, 4 h, and 8 h after surgery. Patients with continuous increases in lactate levels and lactate levels exceeding 5 mmol/L at two or more time points were included in the lactic acidosis group, whereas the other patients were included in the control group. First, univariate correlation analysis was used to identify parameters that were significantly different between the two groups, and then multivariate regression analysis was conducted to elucidate the independent risk factors for lactic acidosis. Fifty-one pairs of patients were screened by propensity score matching analysis (PSM). Then, lactic acid levels at four time points in both groups were analyzed by repeated measures ANOVA. RESULTS: he EF (heart ejection fraction) (OR = 0.94, P = 0.003), aortic occlusion time (OR = 10.17, P < 0.001) and relative infusion rate (OR = 2.23, P = 0.01) of sufentanil was an independent risk factor for lactic acidosis after valvular heart surgery. The patients were further divided into two groups with the mean sufentanil infusion rate as the reference point. The data were filtered with PSM (Propensity Score Matching). Lactic acid values in both groups peaked at 4 h after surgery and then declined. The rate of lactic acid decline was significantly faster in the group with a higher sufentanil dosage than in the lower group. The difference was statistically significant (P < 0.05). There was also a significant difference in lactic acid levels at the four time points (0.1 h, 2 h, 4 h and 8 h after surgery) in both groups (P < 0.001). CONCLUSION: The inadequate intraoperative infusion rate of sufentanil is an independent risk factor for lactic acidosis after heart valve surgery. The possibility of lactic acidosis caused by this factor after cardiac surgery should be considered, which is helpful for postoperative patient management. BioMed Central 2022-09-09 /pmc/articles/PMC9461198/ /pubmed/36085208 http://dx.doi.org/10.1186/s13019-022-01986-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Zhan, Yu-Fei Shi, Quan Pan, Yu-Chen Zheng, Bao-Shi Ge, Yi-Peng Luo, Tian-Ge Xiao, Zhi-Hong Jiang, Wei Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery |
title | Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery |
title_full | Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery |
title_fullStr | Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery |
title_full_unstemmed | Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery |
title_short | Sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery |
title_sort | sufentanil: a risk factor for lactic acidosis in patients after heart valve surgery |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9461198/ https://www.ncbi.nlm.nih.gov/pubmed/36085208 http://dx.doi.org/10.1186/s13019-022-01986-5 |
work_keys_str_mv | AT zhanyufei sufentanilariskfactorforlacticacidosisinpatientsafterheartvalvesurgery AT shiquan sufentanilariskfactorforlacticacidosisinpatientsafterheartvalvesurgery AT panyuchen sufentanilariskfactorforlacticacidosisinpatientsafterheartvalvesurgery AT zhengbaoshi sufentanilariskfactorforlacticacidosisinpatientsafterheartvalvesurgery AT geyipeng sufentanilariskfactorforlacticacidosisinpatientsafterheartvalvesurgery AT luotiange sufentanilariskfactorforlacticacidosisinpatientsafterheartvalvesurgery AT xiaozhihong sufentanilariskfactorforlacticacidosisinpatientsafterheartvalvesurgery AT jiangwei sufentanilariskfactorforlacticacidosisinpatientsafterheartvalvesurgery |