No study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course. After retrospectively registering to clinicaltrial.gov (NCT03816592), we performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass between 2018 and 2019. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 h after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS). One hundred ten patients were matched (OFA: n = 55; OA: n = 55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6–34) vs 5 mg (2–18), p = 0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66–115) vs 77 mmol/l (IQR: 69–95), p = 0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p = 0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1–5) vs 5 (3–6) hours, p = 0.001 and 2 (1–3) vs 3 (2–5) days, p = 0.037). The use of OFA was associated with lower morphine consumption. OFA might be associated with shorter intubation time and ICU stays. Further randomized studies are needed to confirm these results. This study was retrospectively registered to ct2 (identifier: NCT03816592 ) on January 25, 2019.

Minimal invasive heart surgery (MIHS) presents several benefits, but provides intense and prolonged post-operative pain. Our objective was to compare efficacy of serratus anterior plane block (SAPB) with continuous wound infiltration (CWI) for management of post-operative pain following MIHS. It’s retrospective, monocentric study between November 2016 to April 2017. The study was performed at the University hospital of Dijon, Burgundy, France. All patients scheduled for MIHS was included. Data was collected retrospectively. During this period, 20 patients had SAPB and 26 had CWI. SAPB was performed before extubation with a single injection of 0.5 mg/kg of ropivacaïne (5 mg/ml). In the CWI group, catheter was inserted in the subcutaneous space by the surgeon at the end of the procedure. A 10 ml bolus of ropivacaïne (7.5 mg/mL) was followed by a continuous infusion (2 mg/ml) between 7 and 12 ml/h for 48 h. Morphine consumption and visual analog score (VAS) were recorded for 48 h. Length of stay in intensive care unit and hospital was also collected. Morphine consumption and VAS score were significantly lower in SAPB group (p < 0.01). Length of stay in intensive care and hospital was significantly was decreased in SAPB group. SAPB appears effective in reducing postoperative MIHS pain.

Introduction: Gradual reduction of the dosage of norepinephrine (NE) in patients with septic shock is usually left to the physician’s discretion. No hemodynamic indicator predictive of the possibility of decreasing the NE dosage is currently available at the bedside. The respiratory pulse pressure variation/respiratory stroke volume variation (dynamic arterial elastance (Ea_dyn)) ratio has been proposed as an indicator of vascular tone. The purpose of this study was to determine whether Ea_dyn can be used to predict the decrease in arterial pressure when decreasing the NE dosage in resuscitated sepsis patients. Methods: A prospective study was carried out in a university hospital intensive care unit. All consecutive patients with septic shock monitored by PICCO₂ for whom the intensive care physician planned to decrease the NE dosage were enrolled. Measurements of hemodynamic and PICCO₂ variables were obtained before/after decreasing the NE dosage. Responders were defined by a >15% decrease in mean arterial pressure (MAP). Results: In total, 35 patients were included. MAP decreased by >15% after decreasing the NE dosage in 37% of patients (n = 13). Clinical characteristics appeared to be similar between responders and nonresponders. Ea_dyn was lower in responders than in nonresponders (0.75 (0.69 to 0.85) versus 1 (0. 83 to 1.22), P <0.05). Baseline Ea_dyn was correlated with NE-induced MAP variations (r = 0.47, P = 0.005). An Ea_dyn less than 0.94 predicted a decrease in arterial pressure, with an area under the receiver-operating characteristic curve of 0.87 (95% confidence interval (95% CI): 0.72 to 0.96; P <0.0001), 100% sensitivity, and 68% specificity. Conclusions: In sepsis patients treated with NE, Ea_dyn may predict the decrease in arterial pressure in response to NE dose reduction. Ea_dyn may constitute an easy-to-use functional approach to arterial-tone assessment, which may be helpful to identify patients likely to benefit from NE dose reduction.

This study was designed to assess the ability of the stroke volume respiratory variation (ΔrespSV) determined by oesophageal Doppler monitoring (ODM) to predict the response to volume expansion (VE) during pneumoperitoneum. The predictive value of ΔrespSV was evaluated according to the concept of the ‘grey zone’. Patients operated on laparoscopy and monitored by ODM were prospectively included. The exclusion criteria were frequent ectopic beats or preoperative arrhythmia, right ventricular failure, and spontaneous breathing. Haemodynamic parameters and oesophageal Doppler indices [stroke volume (SV), peak velocity (PV), cardiac output (CO), corrected flow time (FTc), respiratory variation of PV (ΔrespPV) and SV (ΔrespSV)] were collected before and after VE. Responders were defined as a ≥15% increase in SV after VE. Thirty-eight (64%) of the 59 patients were responders. A cut-off of >14% ΔrespSV predicted fluid responsiveness with an area under the ROC curve (AUC) of 0.92 [95% confidence interval (CI): 0.82–0.98, P<0.0001]. The grey zone of ΔrespSV ranged between 13 and 15%. With an AUC of 0.71 (95% CI: 0.56–0.83, P=0.005), ΔrespPV fairly accurately predicted fluid responsiveness. FTc was unable to accurately predict fluid responsiveness. ΔrespSV and ΔrespPV predicted fluid responsiveness during laparoscopy under strict physiological conditions. FTc was not predictive of fluid responsiveness during laparoscopy.