Morning or Afternoon Scheduling for Elective Coronary Artery Bypass Surgery: Influence of Longer Fasting Periods from Metabolic and Hemodynamic Perspectives.

IF 1.1 Q3 ANESTHESIOLOGY

Annals of Cardiac Anaesthesia Pub Date : 2024-04-01 DOI:10.4103/aca.aca_204_23

C. Santonocito, Cesare Cassisi, Federica Chiarenza, Alessandro Caruso, Paolo Murabito, M. Maybauer, Shane George, Filippo Sanfilippo

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引用次数: 0

Abstract

BACKGROUND Prolonged preoperative fasting may worsen postoperative outcomes. Cardiac surgery has higher perioperative risk, and longer fasting periods may be not well-tolerated. We analysed the postoperative metabolic and hemodynamic variables in patients undergoing elective coronary artery bypass grafting (CABG) according to their morning or afternoon schedule. METHODS Single-centre retrospective study at University teaching hospital (1-year data collection from electronic medical records). Using a mixed-effects linear regression model adjusted for several covariates, we compared metabolic (lactatemia, pH, and base deficit [BD]) and haemodynamic values (patients on vasoactive support, and vasoactive inotropic score [VIS]) at 7 prespecified time-points (admission to intensive care, and 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours). RESULTS 339 patients (n = 176 morning, n = 163 afternoon) were included. Arterial lactatemia and BD were similar (overall P = 0.11 and P = 0.84, respectively), while pH was significantly lower in the morning group (overall P < 0.05; mean difference -0.01). Postoperative urine output, fluid balance, mean arterial pressure, and central venous pressure were similar (P = 0.59, P = 0.96, P = 0.58 and P = 0.53, respectively). A subgroup analysis of patients with diabetes (n = 54 morning, n = 45 afternoon) confirmed the same findings. The VIS values and the proportion of patients on vasoactive support was higher in the morning cases at the 18th (P = 0.002 and p=0.04, respectively) and 24th postoperative hours (P = 0.003 and P = 0.04, respectively). Mean intensive care length of stay was 1.94 ± 1.36 days versus 2.48 ± 2.72 days for the afternoon and morning cases, respectively (P = 0.02). CONCLUSIONS Patients undergoing elective CABG showed similar or better metabolic and hemodynamic profiles when scheduled for afternoon surgery.

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从代谢和血流动力学角度看长禁食期的影响：从代谢和血流动力学角度看较长禁食期的影响。

背景术前长时间禁食可能会恶化术后效果。心脏手术的围手术期风险较高，较长的禁食期可能无法很好地耐受。我们根据患者上午或下午的时间安排，分析了接受择期冠状动脉旁路移植术（CABG）患者的术后代谢和血流动力学变量。方法在大学教学医院进行单中心回顾性研究（通过电子病历收集 1 年数据）。我们使用混合效应线性回归模型，并对几个协变量进行了调整，比较了 7 个预设时间点（进入重症监护室，术后第 1、3、6、12、18 和 24 小时）的代谢值（乳酸血症、pH 值和碱中毒 [BD]）和血流动力学值（使用血管活性支持的患者和血管活性肌力评分 [VIS]）。动脉乳酸血症和 BD 相似（总体 P = 0.11，P = 0.84），而 pH 值在上午组明显较低（总体 P < 0.05；平均差异 -0.01）。术后尿量、体液平衡、平均动脉压和中心静脉压相似（分别为 P = 0.59、P = 0.96、P = 0.58 和 P = 0.53）。对糖尿病患者（上午 n = 54，下午 n = 45）进行的亚组分析证实了相同的结果。在术后第 18 小时（P = 0.002 和 P=0.04）和第 24 小时（P = 0.003 和 P = 0.04），晨间病例的 VIS 值和接受血管活性支持的患者比例较高。结论择期接受 CABG 手术的患者在安排下午手术时，代谢和血流动力学情况相似或更好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Cardiac Anaesthesia ANESTHESIOLOGY-

CiteScore

1.60

自引率

0.00%

发文量

147

审稿时长

26 weeks

期刊介绍： Annals of Cardiac Anaesthesia (ACA) is the official journal of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. The journal is indexed with PubMed/MEDLINE, Excerpta Medica/EMBASE, IndMed and MedInd. The journal’s full text is online at www.annals.in. With the aim of faster and better dissemination of knowledge, we will be publishing articles ‘Ahead of Print’ immediately on acceptance. In addition, the journal would allow free access (Open Access) to its contents, which is likely to attract more readers and citations to articles published in ACA. Authors do not have to pay for submission, processing or publication of articles in ACA.