Prevention of Organ Dysfunction and Mortality by Monitoring the Administration of Opioids and Hypnotics in Patients at High Postoperative Risk

Inclusion Criteria30

• patients affiliated to the French Social Security;
• informed and signed consent to participating in the study;
• planned postoperative hospitalization > 48 hours;
• patients over 75 years of age with at least one of the following postoperative risk factors:
• ischemic coronary disease;
• history of compensated or prior heart failure;
• stroke;
• significant arrhythmias: fibrillation or auricular flutter with ventricular response > 100/minute, multiform QRS complex) or cardiac conduction abnormalities (trifascicular block, auriculoventricular block of the second or third degree);
• peripheral vascular disease;
• chronic obstructive pulmonary disease;
• chronic respiratory failure;
• renal insufficiency, defined by a creatinine > 175 µmol.l-1 (2 mg.dl-1);
• insulin therapy for diabetes;
• active cancer;
• chronic alcohol abuse;
• dementia.
• elective or emergency high-risk surgery under general anesthesia with a combination of hypnotic and opioid, and intubation or placement of a supraglottic airway control device
• Patients who meet one or more of the preoperative following criteria will not be included:
• acute heart failure or acute myocardial infarction;
• complete arrhythmia due to atrial fibrillation;
• acute respiratory failure or pneumonia;
• septic shock;
• acute stroke;
• cardiac surgery;
• open chest surgery;
• opioid free anesthesia;
• intraoperative ketamine at a dose > 0.25 mg.kg-1; > 0.25 mg/kg or or intravenous electric syringe
• lidocaine or dexmedetomidine by continuous infusion;
• refusal to participate in the study;
• patient under guardianship, conservatorship, or unable to understand the study.