BACKGROUND Although high-opioid anesthesia was long the standard for cardiac surgery, some anesthesiologists now favor multimodal analgesia and low-opioid anesthetic techniques. The typical cardiac surgery opioid dose is unclear, and the degree to which patients, anesthesiologists, and institutions influence this opioid dose is unknown. METHODS We reviewed data from nonemergency adult cardiac surgeries requiring cardiopulmonary bypass performed at 30 academic and community hospitals within the Multicenter Perioperative Outcomes Group registry from 2014 through 2021. Intraoperative opioid administration was measured in fentanyl equivalents. We used hierarchical linear modeling to attribute opioid dose variation to the institution where each surgery took place, the primary attending anesthesiologist, and the specifics of the surgical patient and case. RESULTS Across 30 hospitals, 794 anesthesiologists, and 59,463 cardiac cases, patients received a mean of 1139 (95% confidence interval [CI], 1132-1146) fentanyl mcg equivalents of opioid, and doses varied widely (standard deviation [SD], 872 µg). The most frequently used opioids were fentanyl (86% of cases), sufentanil (16% of cases), hydromorphone (12% of cases), and morphine (3% of cases). 0.6% of cases were opioid-free. 60% of dose variation was explainable by institution and anesthesiologist. The median difference in opioid dose between 2 randomly selected anesthesiologists across all institutions was 600 µg of fentanyl (interquartile range [IQR], 283-1023 µg). An anesthesiologist's intraoperative opioid dose was strongly correlated with their frequency of using a sufentanil infusion (r = 0.81), but largely uncorrelated with their use of nonopioid analgesic techniques (|r| < 0.3). CONCLUSIONS High-dose opioids predominate in cardiac surgery, with substantial dose variation from case to case. Much of this variation is attributable to practice variability rather than patient or surgical differences. This suggests an opportunity to optimize opioid use in cardiac surgery.

中文翻译：

---

心脏手术中的阿片类药物剂量变化：一项多中心实践研究。


背景 尽管高阿片类麻醉长期以来一直是心脏手术的标准，但一些麻醉师现在偏爱多模式镇痛和低阿片类麻醉技术。典型的心脏手术阿片类药物剂量尚不清楚，患者、麻醉师和机构对该阿片类药物剂量的影响程度尚不清楚。方法 我们回顾了 2014 年至 2021 年在多中心围手术期结果组登记册内的 30 家学术和社区医院进行的需要体外循环的非紧急成人心脏手术的数据。术中阿片类药物给药以芬太尼当量测量。我们使用分层线性模型将阿片类药物剂量变化归因于每次手术发生的机构、主要主治麻醉师以及手术患者和病例的具体情况。结果在 30 家医院、794 名麻醉师和 59,463 例心脏病病例中，患者平均接受了 1139 （95% 置信区间 [CI]，1132-1146）芬太尼微克当量的阿片类药物，剂量差异很大（标准差 [SD]，872 μg）。最常用的阿片类药物是芬太尼（86% 的病例）、舒芬太尼（16% 的病例）、氢吗啡酮（12% 的病例）和吗啡（3% 的病例）。0.6% 的病例不含阿片类药物。60% 的剂量变化可由机构和麻醉师解释。所有机构中 2 名随机选择的麻醉师之间的阿片类药物剂量中位数差异为 600 μg 芬太尼（四分位距 [IQR]，283-1023 μg）。麻醉师的术中阿片类药物剂量与他们使用舒芬太尼输注的频率 （r = 0.81） 密切相关，但与他们使用非阿片类镇痛技术基本无关 （|r| < 0.3）。 结论 大剂量阿片类药物在心脏手术中占主导地位，不同病例的剂量差异很大。这种差异在很大程度上归因于实践的差异，而不是患者或手术的差异。这表明有机会优化心脏手术中阿片类药物的使用。