<p>Analgesia and sedation post-coronary artery bypass graft surgery: a review of the literature</p>

Abstract

This review aimed to study the role of analgesia and sedation after coronary artery bypass graft (CABG) surgery, regarding pain management, assisted respiration, overall postoperative health care, and hospitalization. Data were collected from Pubmed, Scopus, and Cochrane databases. The following terms were used for the search: “analgesia”, “sedation”, “coronary artery bypass grafting”, CABG”, and “opioids”. Articles between the years 1988 and 2018 were evaluated. Several opioid and non-opioid analgesics used to relieve surgical pain are regarded as critical risk factors for developing pulmonary and cardiovascular complications in all kinds of thoracic surgery, especially CABG procedures. Effective pain management in post-CABG patients is largely dependent on effective pain assessment, type of sedatives and analgesics administered, and evaluation of their effects on pain relief. A significant challenge is to determine adequate amounts of administered analgesics and sedatives for postoperative CABG patients, because patients often order more sedatives and analgesics than needed. The pain management process is deemed successful when patients feel comfortable after surgery, with no negative side effects. However, postoperative pain management patterns have not included many modern methods such as patient-controlled analgesia, and postoperative pain management drugs are still limited to a restricted range of opioid and non-opioid analgesics.

Can hypnosis and virtual reality reduce anxiety, pain and fatigue among patients who undergo cardiac surgery: a randomised controlled trial

“…Currently, pharmacological treatments for anxiety and pain are well-developed in the ICU environment, where pain and fatigue are most commonly managed by opioid analgesics, propofol and benzodiazepines [14]. Pharmacological treatment could be considered efficient when the patient feels comfortable, with no adverse effects [15]. Yet, opioid analgesics (e.g.…”

“…Yet, opioid analgesics (e.g. morphine) often lead to respiratory sedation, hyperalgesia, depression, nausea, opioid-induced tolerance and dependence [15]. Benzodiazepines can be used in the short term but can lead to strong dependence, with important adverse effects: ataraxia, irritability, nervousness, depression and risk of suicide [16].…”

Comparing the effect of two methods of using ear protective device on pain intensity in patients undergoing coronary artery bypass grafting: A randomized clinical trial

“…[ 1 ] Because of the high intensity of pain and subsequent high stress and serious hemodynamic complications, the management of pain after heart surgery has always been a major concern for physicians and nurses. [ 2 ] To control postoperative pain, pharmacological and non-pharmacological treatments (such as acupuncture, massage, Transcutaneous Electrical Nerve Stimulation [TENS], and heat or cold packs) might be considered. Treatment interventions that are commonly used include opioids, paracetamol, Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), and more recently anticonvulsants.…”

“…However, pain intensity is among the multifactorial problems in patients after CABG, which is affected by a number of uncontrollable factors such as age, gender, health status, and type of intervention. [ 2 ] Moreover, results of a study in 2018 showed that environmental factors such as noise, light, and temperature are stressors for patients admitted to the Intensive Care Unit (ICU). [ 3 ] Kryter,[ 4 ] in his book “Effects of Noise in Man,” proposed that noise stimulates the reticular nervous system, leading to arousal responses of the central nervous system which tends to pain perception in different organs of the body.…”

Postoperative Analgesia with Remifentanil vs Morphine-Metamizole Following Cardiac Surgery

“…(1)(2)(3). actually, there are too many drugs used in postoperative period for reducing pain: nSaiD, ketamine, Dexmedetomidine, magnesium, local anesthetics, gabapentin, epidural anesthesia, (4). Major role in cardiac anesthesia plays high doses of opioids, but can lead to prolonged sedation and delay in tracheal extubation.…”