Opioid-Free Anesthesia in Cardiac Surgery

Inclusion Criteria:

• Patients having planned cardiac surgery under cardiopulmonary bypass, with at leastone coronary artery bypass grafting and rf at least one internal mammary artery asgraft; possible association with aortic valve replacement
• Patient having red and understood the information letter and signed the consent form
• For women : of childbearing age, need to confirm the absence of an active pregnancy bya negative blood pregnancy test within 48 hours prior to inclusion / menopausal (amenorrhea not medically induced for at least 12 months before the inclusion visit)
• Patient affiliated to a social security scheme

Exclusion Criteria:

• Preoperative treatment with morphine or its derivatives (including tramadol) in the 15days preceding the inclusion visit
• Pre-existing high-degree conduction disorder
• Bradycardia < 50 bpm
• Oxygen therapy prior to inclusion
• Heart failure with LVEF <40%
• BMI ≥ 35 kg/m²
• Myocardial suffering in the 5 days preceding inclusion
• Patient in shock
• Known adrenal insufficiency and / or long-term systemic corticosteroid treatment (equivalent to hydrocortisone hemisuccinate ≥ 20 mg / day)
• Combined surgery other than aortic valve
• Long-term non-invasive ventilation (including for obstructive sleep apnea syndrome)
• Any antecedent or active practice (s) of drug addiction;
• Contraindication to one of the experimental and / or non-experimental treatments:dexmedetomidine, lidocaine, dexamethasone, ketamine, remifentanil or morphine
• Acute cerebrovascular pathology,
• Severe hepatic insufficiency (factor V level <50%),
• Pre-existing cognitive disorders,
• Patient for whom the CAM-ICU questionnaire cannot be carried out (deaf patients forexample),
• Pregnant or parturient or breastfeeding woman
• Person deprived of liberty by an administrative or judicial decision or person placedunder judicial protection / under guardianship or guardianship
• Patient participating in another drug trial or having participated in another drugtrial within 1 month before randomization