{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:49:56Z","timestamp":1788922196534,"version":"build-2803163510"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the impact of intraoperative methadone on early extubation and opioid use in the perioperative period (intraoperative, &lt;12 hours postoperatively, &gt;12 hours postoperatively) in intravenous drug users (IVDU) undergoing cardiac valvular surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective chart review of the electronic medical record. Data was collected from a single large rural academic medical center over a 14-month period. Patients with active or history of IV drug use who underwent cardiothoracic surgery and who received methadone intraoperatively were included in the analysis. Exclusion criteria included discharge less than 72 hours postoperatively, a documented allergy to methadone, and patients who were on oral methadone preoperatively. 61 patients received a single dose of IV methadone intraoperatively. 24 matched comparator patients did not receive any methadone. These 2 groups were compared on time to extubation using a Cochran-Mantel-Haenszel method to analyze the categorical data (intraoperative, &lt;12 hours postoperatively, &gt;12 hours postoperatively). Furthermore, groups were compared based on morphine equivalents intraoperatively and postoperatively, and the amount of anesthesia given intraoperatively and postoperatively by examining dexmedetomidine (intraoperative and postoperative) and ketamine requirements using Independent sample t-tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and main results<\/jats:title>\n                    <jats:p>91% of patients in the methadone group were extubated within 12 hours compared to 66% in the control group (p = 0.0006) demonstrating a significant linear association. There was no significant difference with regard to use of morphine equivalents, however, there was a significant difference in the dose of dexmedetomidine administered postoperatively between the methadone and control group (42.9 vs. 108, p = 0.039).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Administering a single dose of IV methadone intraoperatively in patients with an IV drug use history may facilitate earlier extubation and reduce postoperative sedation (dexmedetomidine) requirements.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-025-03446-8","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T14:06:40Z","timestamp":1766498800000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of intraoperative methadone on early extubation and opioid utilization in intravenous drug users undergoing cardiac surgery"],"prefix":"10.1186","volume":"25","author":[{"given":"Abigail","family":"Hoff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew B.","family":"Ellison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galen","family":"Kabulski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alec","family":"Statler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conner D.","family":"Funke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. W. Awori","family":"Hayanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavithra R.","family":"Ellison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"3446_CR1","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1097\/01.sa.0000484583.65548.09","volume":"122","author":"GS Murphy","year":"2015","unstructured":"Murphy GS, Szokol JW, Avram MJ, et al. Intraoperative methadone for the prevention of postoperative pain. A randomized, double-blinded clinical trial in cardiac surgical patients. J Am Soc Anesthesiologists. 2015;122:1112\u201322. https:\/\/doi.org\/10.1097\/01.sa.0000484583.65548.09.","journal-title":"J Am Soc Anesthesiologists"},{"key":"3446_CR2","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1378\/chest.118.2.391","volume":"118","author":"XM Mueller","year":"2000","unstructured":"Mueller XM, Tinguely F, Tevaearai HT, et al. Pain location, distribution, and intensity after cardiac surgery. Chest. 2000;118:391\u20136. https:\/\/doi.org\/10.1378\/chest.118.2.391.","journal-title":"Chest"},{"key":"3446_CR3","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1097\/ALN.0b013e31828866b3","volume":"118","author":"HJ Gerbershagen","year":"2013","unstructured":"Gerbershagen HJ, Aduckathil S, van Wijck AJ, et al. Pain intensity on the first day after surgery. A prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118:934\u201344. https:\/\/doi.org\/10.1097\/ALN.0b013e31828866b3.","journal-title":"Anesthesiology"},{"key":"3446_CR4","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/00006199-199401000-00006","volume":"43","author":"K Puntillo","year":"1994","unstructured":"Puntillo K, Weiss SJ, Pain. Its mediators and associated morbidity in critically ill cardiovascular surgical patients. Nurs Res. 1994;43:31\u20136. https:\/\/doi.org\/10.1097\/00006199-199401000-00006.","journal-title":"Nurs Res"},{"key":"3446_CR5","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1017\/S0265021506000548","volume":"23","author":"L Roediger","year":"2006","unstructured":"Roediger L, Larbuisson R, Lamy M. New approaches and old controversies to postoperative pain control following cardiac surgery. Eur J Anaesthesiol. 2006;23:539\u201350. https:\/\/doi.org\/10.1017\/S0265021506000548.","journal-title":"Eur J Anaesthesiol"},{"key":"3446_CR6","unstructured":"Lexi-drugs online [database on the Internet]. Waltham (MA): UpToDate Inc.; 2018 [updated 6 Jan 2024; cited 10 Feb 2024]. Available from: https:\/\/online.lexi.com."},{"key":"3446_CR7","unstructured":"Methadone hydrochloride injection [package insert]. Lake Forest, IL: Akorn Corporation; 2019."},{"key":"3446_CR8","doi-asserted-by":"publisher","DOI":"10.1151\/ascp08424","volume":"4","author":"SR Savage","year":"2008","unstructured":"Savage SR, Kirsh KL, Passik SD. Challenges in using opioids to treat pain in persons with substance use disorders. Addict Sci Clin Pract. 2008;4:4. https:\/\/doi.org\/10.1151\/ascp08424.","journal-title":"Addict Sci Clin Pract"},{"key":"3446_CR9","unstructured":"Camp SL, Stamou SC, Stiegel RM, et al. Can timing of tracheal extubation predict improved outcomes after cardiac surgery? HSR Proceedings in Intensive Care & Cardiovascular Anesthesia. 2009;1:39.PMID: 23439795; PMCID: PMC3484547."},{"key":"3446_CR10","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/S0003-4975(95)00356-8","volume":"60","author":"KV Arom","year":"1995","unstructured":"Arom KV, Emery RW, Petersen RJ, et al. Cost-effectiveness and predictors of early extubation. Ann Thorac Surg. 1995;60:127\u201332. https:\/\/doi.org\/10.1016\/S0003-4975(95)00356-8.","journal-title":"Ann Thorac Surg"},{"key":"3446_CR11","doi-asserted-by":"publisher","unstructured":"Hawkes CA, Dhileepan S, Foxcroft DR. Early extubation for adult cardiac surgical patients. Cochrane Database Syst Reviews. 2003;4. https:\/\/doi.org\/10.1002\/14651858.CD003587.","DOI":"10.1002\/14651858.CD003587"},{"issue":"5","key":"3446_CR12","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1164\/ajrccm.161.5.9905102","volume":"161","author":"WM Coplin","year":"2000","unstructured":"Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161(5):1530\u20136. https:\/\/doi.org\/10.1164\/ajrccm.161.5.9905102.","journal-title":"Am J Respir Crit Care Med"},{"key":"3446_CR13","doi-asserted-by":"publisher","first-page":"1624","DOI":"10.1001\/jama.2016.1464","volume":"315","author":"D Dowell","year":"2016","unstructured":"Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain. JAMA. 2016;315:1624\u201345. https:\/\/doi.org\/10.1001\/jama.2016.1464.","journal-title":"JAMA"},{"key":"3446_CR14","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/S0022-5223(19)35692-2","volume":"95","author":"SA Gall Jr","year":"1988","unstructured":"Gall SA Jr, Olsen CO, Reves JG, et al. Beneficial effects of endotracheal extubation on ventricular performance: implications for early extubation after cardiac operations. J Thorac Cardiovasc Surg. 1988;95:819\u201327. https:\/\/doi.org\/10.1016\/S0022-5223(19)35692-2.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"3446_CR15","doi-asserted-by":"publisher","DOI":"10.4266\/acc.2019.00451","volume":"34","author":"SY Park","year":"2019","unstructured":"Park SY, Lee HB. Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines. Acute Crit Care. 2019;34:117. https:\/\/doi.org\/10.4266\/acc.2019.00451.","journal-title":"Acute Crit Care"},{"key":"3446_CR16","doi-asserted-by":"publisher","unstructured":"Kollef MH, Levy NT, Ahrens TS et al. The use of continuous i.v. Sedation is associated with prolongation of mechanical ventilation chest. 1998;114:541\u20138, https:\/\/doi.org\/10.1378\/chest.114.2.541","DOI":"10.1378\/chest.114.2.541"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-025-03446-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-025-03446-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-025-03446-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T14:06:41Z","timestamp":1766498801000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12871-025-03446-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,23]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3446"],"URL":"https:\/\/doi.org\/10.1186\/s12871-025-03446-8","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,23]]},"assertion":[{"value":"23 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Declarations"}},{"value":"This study was approved by the West Virginia University Institutional Review Board with an IRB protocol number 1808254147.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"611"}}