Jessica Spence1, Emilie Belley-Côté2, P J Devereaux3, Richard Whitlock4, Kevin Um5, Graham McClure5, Andre Lamy4, Yannick LeManach6, Stuart Connolly7, Summer Syed8. 1. Departments of Anesthesia and Critical Care and Health Research Methods, Evidence, and Impact, McMaster University, Population Health Research Institute (PHRI), 2V9-1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. jessicaspence13@gmail.com. 2. Departments of Anesthesia and Critical Care, Medicine (Cardiology) and Health Research Methods, Evidence, and Impact, McMaster University, Population Health Research Institute, Hamilton, ON, Canada. 3. Departments of Medicine (Cardiology) and Health Research Methods, Evidence, and Impact, McMaster University, Population Health Research Institute, Hamilton, ON, Canada. 4. Departments of Surgery (Cardiac Surgery) and Health Research Methods, Evidence, and Impact, McMaster University, Population Health Research Institute, Hamilton, ON, Canada. 5. Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. 6. Departments of Anesthesia and Critical Care and Health Research Methods, Evidence, and Impact, McMaster University, Population Health Research Institute (PHRI), 2V9-1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. 7. Department of Medicine (Cardiology), McMaster University, Population Health Research Institute, Hamilton, ON, Canada. 8. Department of Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada.
Abstract
BACKGROUND: Benzodiazepines are commonly administered during cardiac surgery because of their limited effect on hemodynamics and presumed role in preventing intraoperative awareness. Recent concerns about an increased risk of delirium with benzodiazepines have resulted in decreased usage in the intensive care unit and in geriatric perioperative practice. Little is known, however, about current benzodiazepine usage in the setting of adult cardiac surgery. METHODS: We contacted all academic anesthesia departments in Canada to identify practicing attending cardiac anesthesiologists; this group constituted our sampling frame. Information regarding participant demographics, benzodiazepine usage, type, dose, and other administration details were obtained by electronic survey. Responses were analyzed descriptively. RESULTS: The survey was completed by 243/346 (70%) of cardiac anesthesiologists. Eleven percent of respondents do not administer benzodiazepines. Midazolam was the most commonly used benzodiazepine, with a mean (standard deviation) dose of 4.9 (3.8) mg given to an average patient. When respondents were asked the proportion of patients that they gave benzodiazepines, the response was bimodal. The most common considerations that influenced benzodiazepine use were patient age (73%), patient anxiety (63%), history of alcohol/drug/benzodiazepine use (60%), and the presence of risk factors for intraoperative awareness (44%). CONCLUSIONS: Benzodiazepine use is common among academic cardiac anesthesiologists in Canada. Nonetheless, heterogeneity exists between individual practices, suggesting clinical equipoise between restrictive and liberal administration of benzodiazepines for cardiac anesthesia. L'administration de benzodiazépines pendant la chirurgie cardiaque chez l'adulte: évaluation de la pratique actuelle des anesthésiologistes canadiens exerçant en milieu universitaire.
BACKGROUND:Benzodiazepines are commonly administered during cardiac surgery because of their limited effect on hemodynamics and presumed role in preventing intraoperative awareness. Recent concerns about an increased risk of delirium with benzodiazepines have resulted in decreased usage in the intensive care unit and in geriatric perioperative practice. Little is known, however, about current benzodiazepine usage in the setting of adult cardiac surgery. METHODS: We contacted all academic anesthesia departments in Canada to identify practicing attending cardiac anesthesiologists; this group constituted our sampling frame. Information regarding participant demographics, benzodiazepine usage, type, dose, and other administration details were obtained by electronic survey. Responses were analyzed descriptively. RESULTS: The survey was completed by 243/346 (70%) of cardiac anesthesiologists. Eleven percent of respondents do not administer benzodiazepines. Midazolam was the most commonly used benzodiazepine, with a mean (standard deviation) dose of 4.9 (3.8) mg given to an average patient. When respondents were asked the proportion of patients that they gave benzodiazepines, the response was bimodal. The most common considerations that influenced benzodiazepine use were patient age (73%), patientanxiety (63%), history of alcohol/drug/benzodiazepine use (60%), and the presence of risk factors for intraoperative awareness (44%). CONCLUSIONS:Benzodiazepine use is common among academic cardiac anesthesiologists in Canada. Nonetheless, heterogeneity exists between individual practices, suggesting clinical equipoise between restrictive and liberal administration of benzodiazepines for cardiac anesthesia. L'administration de benzodiazépines pendant la chirurgie cardiaque chez l'adulte: évaluation de la pratique actuelle des anesthésiologistes canadiens exerçant en milieu universitaire.
Authors: Jessica Spence; Emilie Belley-Côté; Simon Oczkowski; Eric Jacobsohn; Richard Whitlock; P J Devereaux; Stuart Connolly Journal: Can J Anaesth Date: 2018-10-17 Impact factor: 5.063
Authors: Jessica Spence; Jack Young; Waleed Alhazzani; Richard Whitlock; Frédérick D'Aragon; Kevin Um; David Mazer; Chris Beaver; Eric Jacobsohn; Emilie Belley-Cote Journal: BMJ Open Date: 2019-12-11 Impact factor: 2.692