Analgesia and sedation post-coronary artery bypass graft surgery: a review of the literature

Figures & data

Table 1 Analgesics and sedatives for pain treatment after coronary surgery

Analgesics and sedatives	Mechanism of action	Adverse effects
Opioids	Different opioid analgesics vary in their affinity to opioid receptors, and therefore they have a variety of pharmacodynamic properties	Respiratory sedation, depression, nausea and vomiting, gastrointestinal atony, and pruritus; opioid-induced tolerance and hyperalgesia
Gabapentin	Gabapentin reduces neurotransmitter release via a calcium-dependent mechanism or NMDA-mediated decrease in the glutamate-releasing mechanism
Paracetamol	Acts via inhibiting prostaglandin synthesis, by increasing descending serotonergic impulses that are antinococeptive, or via indirectly activating cannabinoid CB1 receptors	Increased risk of gastrointestinal bleeding and a small increase in systolic blood pressure
NSAIDs	Cyclooxygenase inhibitors	Gastrointestinal tract effects, blood pressure elevation, and development of congestive heart failure
Ketamine	Works as a non-competitive antagonist of NMDA receptors	Psychotomimetic adverse effects
Magnesium	Analgesic effects related to the calcium channel antagonist effect and blocking the NMDA channel	Hypotension
Propofol		Hypotension
Dexmedetomidine	Stimulates α2-adrenoreceptors in the central nervous system	Hypotension and bradycardia

Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; NMDA, N-methyl-d-aspartate.