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

Inclusion Criteria:

• 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:

Non inclusion criteria:

• Patients who meet one or more of the preoperative following criteria will not be included:

• acute heart failure or acute myocardial infarction;

• acute respiratory failure or pneumonia;

• septic shock;

• acute stroke;

• cardiac surgery;

• open chest surgery;

• opioid free anesthesia;

• intraoperative ketamine at a dose > 0.2 mg.kg-1;

• lidocaine or dexmedetomidine by continuous infusion;

• refusal to participate in the study;