Key result
Intraoperative use of remifentanil was associated with a significant increase in postoperative complications in patients with reduced LVEF compared to those with normal LVEF (interaction OR 2.71).
Why the study?
Few data exist to guide intraoperative management of patients with reduced LVEF, leaving unclear how management differs and which treatments confer differential risk.
Does intraoperative remifentanil use increase postoperative complications in patients with reduced LVEF undergoing non-cardiac surgery?
Cohort (n=9,420)
No
Does intraoperative remifentanil use increase postoperative complications in patients with reduced LVEF undergoing non-cardiac surgery?
In patients with reduced LVEF undergoing non-cardiac surgery, intraoperative use of remifentanil is associated with a significantly increased risk of postoperative complications, highlighting the need for tailored anesthetic management in this population.
Remifentanil use warrants caution in reduced-LVEF patients undergoing noncardiac surgery; leaves open whether the association is causal or confounded.
BACKGROUND: There are few data to guide the intraoperative management of patients with reduced left ventricular ejection fraction (LVEF). This study aimed to describe how patients with reduced LVEF are managed differently and to identify and treatments had a different risk profile in this population. METHODS: We performed a retrospective cohort study of adult patients who underwent general anesthesia for non-cardiac surgery. The effect of anesthesia medications and fluid balance was compared between those with and without a reduced preoperative LVEF. The primary outcome was a composite of acute kidney injury, myocardial injury, pulmonary complications, and 30-day mortality. Multivariable logistic regression was used to adjust for confounders. Treatments that affected patients with reduced LVEF differently were defined as those associated with the primary outcome that also had a significant interaction with LVEF. RESULTS: A total of 9420 patients were included. Patients with reduced LVEF tended to have a less positive fluid balance. Etomidate, calcium, and phenylephrine were use more frequently, while propofol and remifentanil were used less frequently. Remifentanil affected patients with reduced LVEF differently than those without (interaction term OR 2.71, 95% CI 1.30-5.68, p = 0.008). While the use of remifentanil was associated with fewer complications in patients with normal systolic function (OR 0.54, 95% CI 0.42-0.68, p < 0.001), it was associated with an increase in complications in patients with reduced LVEF (OR = 3.13, 95% CI 3.06-5.98, p = 0.026). CONCLUSIONS: Patients with a reduced preoperative LVEF are treated differently than those with a normal LVEF when undergoing non-cardiac surgery. An association was found between the use of remifentanil and an increase in postoperative adverse events that was unique to this population. Future research is needed to determine if this relationship is secondary to the medication itself or reflects a difference in how remifentanil is used in patients with reduced LVEF.
No takes yet. Share an insight, caveat, or question.
Maile et al. (2022) conducted a cohort in Reduced left ventricular ejection fraction (n=9,420). Remifentanil vs. Unexposed / Normal LVEF was evaluated on Composite of acute kidney injury, myocardial injury, pulmonary complications, and 30-day mortality (OR 2.71, 95% CI 1.30-5.68, p=0.008). Intraoperative use of remifentanil was associated with a significant increase in postoperative complications in patients with reduced LVEF compared to those with normal LVEF (interaction OR 2.71).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: