{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:31:15Z","timestamp":1783423875202,"version":"3.54.6"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Dexmedetomidine, an alpha-2 agonist, is used as an adjunct to anesthesia in enhanced recovery after surgery (ERAS) programs. One of its advantages is the opioid-sparing effect which can facilitate early extubation and recovery. When the ERAS cardiac society was set in 2017, our facility was already using the ERAS program, in which the \u201cfast-track Anesthesia\u201d was facilitated by the intraoperative infusion of dexmedetomidine. Our objective is to share our experience and investigate the potential impact of intraoperative dexmedetomidine use as a part of the ERAS program on patient outcomes in elective cardiac surgery. Materials and Methods: An observational retrospective cohort study was conducted at a university hospital in Switzerland. The patients who underwent elective cardiac surgery with cardiopulmonary bypass between 1 June 2017 and 31 August 2018 were included in this analysis (n = 327). Regardless of the surgery type, all the patients received a standardized fast-track anesthesia protocol inclusive of dexmedetomidine infusion, reduced opioid dose, and parasternal nerve block. The primary outcome was the postoperative time when the criteria for extubation were met. Three groups were identified: group 0\u2014(extubated in the operating room), group &lt; 6 (extubated in less than 6 h), and group &gt; 6 (extubated in &gt;6 h). The secondary outcomes were adverse events, length of stay in ICU and in hospital, and total hospitalization costs. Results: Dexmedetomidine was well-tolerated, with no significant adverse events reported. Early extubation was performed in 187 patients (57%). Group 3 had a significantly longer length of stay in the ICU (median: 70 h vs. 25 h) and in hospital (17 vs. 12 days), and consequently higher total hospitalization costs (CHF 62,551 vs. 38,433) compared to the net data from the other two groups (p &lt; 0.0001). Conclusions: Our findings suggest that dexmedetomidine can be safely used as part of the opioid-sparing anesthesia protocol in patients undergoing elective cardiac surgery with cardiopulmonary bypass with the potential to facilitate early extubation, shorter ICU and hospital stays, and reduced hospitalization costs.<\/jats:p>","DOI":"10.3390\/medicina60071036","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T03:38:40Z","timestamp":1719286720000},"page":"1036","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Intraoperative Dexmedetomidine Use for Enhanced Recovery after Surgery (ERAS) in Cardiac Surgery\u2014Single Center Retrospective Observational Cohort Study"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0233-2861","authenticated-orcid":false,"given":"Axel","family":"Kerroum","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Rosner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuelle","family":"Scala","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9213-7578","authenticated-orcid":false,"given":"Matthias","family":"Kirsch","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lausanne University Hospital, 1005 Lausanne, Switzerland"},{"name":"Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2608-7568","authenticated-orcid":false,"given":"Piergiorgio","family":"Tozzi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lausanne University Hospital, 1005 Lausanne, Switzerland"},{"name":"Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Courbon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Rusca","sequence":"additional","affiliation":[{"name":"Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland"},{"name":"Department of Intensive Care Medicine, Lausanne University Hospital, 1005 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9183-7783","authenticated-orcid":false,"given":"Silvijus","family":"Abramavi\u010dius","sequence":"additional","affiliation":[{"name":"Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Povilas","family":"Andrijauskas","sequence":"additional","affiliation":[{"name":"II Department of Anaesthesiology and Intensive Care, Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Marcucci","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland"},{"name":"Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Rancati","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s00268-018-4844-y","article-title":"Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS (R)) Society Recommendations: 2018","volume":"43","author":"Gustafsson","year":"2019","journal-title":"World J. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.14797\/mdcj-14-2-77","article-title":"The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery","volume":"14","author":"Brown","year":"2018","journal-title":"Methodist. Debakey Cardiovasc. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1007\/s00268-016-3700-1","article-title":"Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations","volume":"40","author":"Melloul","year":"2016","journal-title":"World J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1001\/jamasurg.2019.1153","article-title":"Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations","volume":"154","author":"Engelman","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1213\/01.ane.0000263034.96885.e1","article-title":"The role of the anesthesiologist in fast-track surgery: From multimodal analgesia to perioperative medical care","volume":"104","author":"White","year":"2007","journal-title":"Anesth. Analg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1038\/ki.2015.306","article-title":"Perioperative dexmedetomidine reduces the incidence and severity of acute kidney injury following valvular heart surgery","volume":"89","author":"Cho","year":"2016","journal-title":"Kidney Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1053\/j.jvca.2013.06.022","article-title":"Perioperative dexmedetomidine improves mortality in patients undergoing coronary artery bypass surgery","volume":"28","author":"Ji","year":"2014","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"R169","DOI":"10.1186\/cc11646","article-title":"Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? a meta-analysis","volume":"16","author":"Lin","year":"2012","journal-title":"Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.jcrc.2016.10.026","article-title":"Dexmedetomidine vs propofol sedation reduces delirium in patients after cardiac surgery: A meta-analysis with trial sequential analysis of randomized controlled trials","volume":"38","author":"Liu","year":"2017","journal-title":"J. Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/anae.15947","article-title":"Dexmedetomidine for adult cardiac surgery: A systematic review, meta-analysis and trial sequential analysis","volume":"78","author":"Poon","year":"2023","journal-title":"Anaesthesia"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wang, G., Niu, J., Li, Z., Lv, H., and Cai, H. (2018). The efficacy and safety of dexmedetomidine in cardiac surgery patients: A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0202620"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1097\/00000542-199702000-00009","article-title":"Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting","volume":"86","author":"Jaionen","year":"1997","journal-title":"Anesthesiology"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Aguerreche, C., Cadier, G., Beurton, A., Imbault, J., Leuillet, S., Remy, A., Zaouter, C., and Ouattara, A. (2021). Feasibility and postoperative opioid effect of an opioid-free anaesthesia in adult cardiac surgery: A retrospective study. BMC Anesthesiol., 21.","DOI":"10.1186\/s12871-021-01362-1"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kostroglou, A., Kapetanakis, E.I., Matsota, P., Tomos, P., Kostopanagiotou, K., Tomos, I., Siristatidis, C., Papapanou, M., and Sidiropoulou, T. (2021). Monitored Anesthesia Care with Dexmedetomidine Supplemented by Midazolam\/Fentanyl versus Midazolam\/Fentanyl Alone in Patients Undergoing Pleuroscopy: Effect on Oxygenation and Respiratory Function. J. Clin. Med., 10.","DOI":"10.3390\/jcm10163510"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/S0002-9149(98)00498-6","article-title":"Analysis of risk factors for development of atrial fibrillation early after cardiac valvular surgery","volume":"82","author":"Asher","year":"1998","journal-title":"Am. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1161\/CIRCULATIONAHA.108.777789","article-title":"Atrial fibrillation after isolated coronary surgery affects late survival","volume":"118","author":"Mariscalco","year":"2008","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1001\/jama.291.14.1720","article-title":"A multicenter risk index for atrial fibrillation after cardiac surgery","volume":"291","author":"Mathew","year":"2004","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"615987","DOI":"10.1155\/2014\/615987","article-title":"Postoperative arrhythmias after cardiac surgery: Incidence, risk factors, and therapeutic management","volume":"2014","author":"Peretto","year":"2014","journal-title":"Cardiol. Res. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1053\/j.jvca.2006.09.003","article-title":"Parasternal intercostal block with ropivacaine for pain management after cardiac surgery: A double-blind, randomized, controlled trial","volume":"21","author":"Barr","year":"2007","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1213\/ANE.0b013e3182147f6d","article-title":"Review articles: Postoperative delirium: Acute change with long-term implications","volume":"112","author":"Rudolph","year":"2011","journal-title":"Anesth. Analg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jclinane.2018.06.045","article-title":"Perioperative dexmedetomidine reduces delirium after cardiac surgery: A meta-analysis of randomized controlled trials","volume":"50","author":"Wu","year":"2018","journal-title":"J. Clin. Anesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1053\/j.jvca.2021.09.024","article-title":"Dexmedetomidine Use in Intensive Care Unit Sedation and Postoperative Recovery in Elderly Patients Post-Cardiac Surgery (DIRECT)","volume":"36","author":"Chitnis","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.bja.2020.10.041","article-title":"Propofol plus low-dose dexmedetomidine infusion and postoperative delirium in older patients undergoing cardiac surgery","volume":"126","author":"Momeni","year":"2021","journal-title":"Br. J. Anaesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1001\/jama.2019.0234","article-title":"Effect of Intravenous Acetaminophen vs Placebo Combined with Propofol or Dexmedetomidine on Postoperative Delirium among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial","volume":"321","author":"Subramaniam","year":"2019","journal-title":"JAMA"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1036\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:03:48Z","timestamp":1760108628000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,25]]},"references-count":24,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["medicina60071036"],"URL":"https:\/\/doi.org\/10.3390\/medicina60071036","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,25]]}}}