Enhanced Recovery After Surgery (ERAS) in Coronary Artery Bypass Graft / Off Pump Coronary Artery Bypass (CABG/OPCAB)

NCT ID: NCT03956420

Last Updated: 2019-05-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-05-03

Study Completion Date

2021-05-31

Brief Summary

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It has been assumed that some elements of the ERAS protocol may contribute to the reduction of complications and improve the satisfaction of patients undergoing coronary artery bypass surgery.

Elements of the ERAS strategy will be tested in this study. The elements that prove to be feasible and have a positive effect on the treatment process will be introduced into everyday clinical practice.

In the next stage of the research, we are planning to investigate whether the introduction of the ERAS strategy has had a long-term positive effect on the quality of life after treatment (a survey 1 month and 6 months after leaving the hospital).

Detailed Description

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Evaluation of the impact of implemented elements of the ERAS strategy on the results of surgical treatment of coronary artery disease in the aspect of:

* preoperative preparation (comprehensive information, premedication, hydration),
* haemodynamic stability (discontinuation of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers immediately before surgery), optimal pre- and intraoperative fluid therapy,
* occurrence of respiratory complications (assessment of the duration of mechanical ventilation and passive oxygen therapy),
* demand for painkillers in the postoperative period, after introducing the preemptive strategy,
* incidence of postoperative delirium,
* time to recovery of the normal bowel function (nausea, vomiting),
* possibility of early mobilisation on the first day after surgery,
* patient's satisfaction with treatment assessed on the basis of a survey carried out on the day before leaving the hospital.

Conditions

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Coronary Artery Disease Coronary Stenosis

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

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Study group

Implemented ERAS (Early Recovery After Surgery) elements

Premedication visit

Intervention Type BEHAVIORAL

detailed information about surgery, anaesthesia and postoperative period

Preoperative period

Intervention Type DIETARY_SUPPLEMENT

avoidance of prolonged fasting, intake of fluids with carbohydrates before surgery

Preoperative period

Intervention Type DRUG

administration of melatonin 5 mg in the evening and pregabalin 75 mg one hour before entering the operating theatre

Postoperative period

Intervention Type OTHER

Fluids 1 ml/kg/h; Discontinuation of propofol at the moment of drainage and cardiovascular system stabilization; Fluids administered orally 2 hours after extubation; Early mobilisation

Intraoperative period

Intervention Type OTHER

deep temperature (necessity to maintain normothermia during the stay in the operating theatre 36 °C. Normothermia should be maintained rather than restored.

Intraoperative period

Intervention Type DRUG

Pyralgin 1 g i.v. after induction of anaesthesia; in patients allergic to Pyralginum, Perfalgan 1 g i.v.

Intraoperative period

Intervention Type DRUG

Ketamine 30 mg i.v. after induction of anaesthesia

Intraoperative period

Intervention Type DRUG

Sevoflurane 1.5 MAC higher in patients \< 60 years old

Intraoperative period

Intervention Type DRUG

Propofol infusion in patients at risk of postoperative vomiting (Apfel ≥ 2 points), sevoflurane administration at the moments of strong stimuli from the operating field

Intraoperative period

Intervention Type DRUG

Continuous infusion of balanced multi-electrolyte fluids 1-3 ml/kg/h

Control group

The control group will consist of patients treated during the study in accordance with the current standards used in the Department

No interventions assigned to this group

Interventions

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Premedication visit

detailed information about surgery, anaesthesia and postoperative period

Intervention Type BEHAVIORAL

Preoperative period

avoidance of prolonged fasting, intake of fluids with carbohydrates before surgery

Intervention Type DIETARY_SUPPLEMENT

Preoperative period

administration of melatonin 5 mg in the evening and pregabalin 75 mg one hour before entering the operating theatre

Intervention Type DRUG

Postoperative period

Fluids 1 ml/kg/h; Discontinuation of propofol at the moment of drainage and cardiovascular system stabilization; Fluids administered orally 2 hours after extubation; Early mobilisation

Intervention Type OTHER

Intraoperative period

deep temperature (necessity to maintain normothermia during the stay in the operating theatre 36 °C. Normothermia should be maintained rather than restored.

Intervention Type OTHER

Intraoperative period

Pyralgin 1 g i.v. after induction of anaesthesia; in patients allergic to Pyralginum, Perfalgan 1 g i.v.

Intervention Type DRUG

Intraoperative period

Ketamine 30 mg i.v. after induction of anaesthesia

Intervention Type DRUG

Intraoperative period

Sevoflurane 1.5 MAC higher in patients \< 60 years old

Intervention Type DRUG

Intraoperative period

Propofol infusion in patients at risk of postoperative vomiting (Apfel ≥ 2 points), sevoflurane administration at the moments of strong stimuli from the operating field

Intervention Type DRUG

Intraoperative period

Continuous infusion of balanced multi-electrolyte fluids 1-3 ml/kg/h

Intervention Type DRUG

Other Intervention Names

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Normothermia

Eligibility Criteria

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Inclusion Criteria

* CABG/OPCAB (Coronary Artery Bypass Surgery/Off Pump Coronary Bypass Surgery).
* Left ventricular ejection fraction above 35% (EF ≥ 35%).
* The operation was performed in a planned mode.

Exclusion Criteria

* Haematological diseases and the associated increased risk of bleeding in the early postoperative period. Patients taking anticoagulants until the day of surgery with the exception of aspirin.
* Neurological disorders, stroke with persistent symptoms, dementia.
* Chronic lung disease with hypoxia and the need for regular medication.
* Inability to move independently, disability preventing efficient rehabilitation, prolonged use of painkillers.
* Emergency surgery, reoperation.
* Return to the operating room regardless of the reason (resternotomy).
* Perioperative infarction with circulatory destabilization.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Silesian University of Medicine

OTHER

Sponsor Role lead

Responsible Party

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Ewa Kucewicz-Czech

Clinical Professor, Head of Unit

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ewa Kucewicz-Czech

Role: STUDY_CHAIR

Upper-Silesian Medical Centre; DEPARTMENT OF ANAESTHESIOLOGY AND INTENSIVE CARE WITH CARDIAC MONITORING

Locations

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Upper-Silesian Medical Centre of the Silesian Medical University

Katowice, Polska, Poland

Site Status

Countries

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Poland

Other Identifiers

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KNW/0022/KB1/26/18

Identifier Type: -

Identifier Source: org_study_id

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