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. 2025 Dec 23;25(1):611.
doi: 10.1186/s12871-025-03446-8.

Impact of intraoperative methadone on early extubation and opioid utilization in intravenous drug users undergoing cardiac surgery

Abigail Hoff  1 , Matthew B Ellison  2   3 , Galen Kabulski  2   4 , Alec Statler  2   5 , Conner D Funke  6 , J W Awori Hayanga  2   7 , Pavithra R Ellison  2   5
Affiliations

Impact of intraoperative methadone on early extubation and opioid utilization in intravenous drug users undergoing cardiac surgery

Abigail Hoff et al. BMC Anesthesiol. .

Abstract

Objectives: To evaluate the impact of intraoperative methadone on early extubation and opioid use in the perioperative period (intraoperative, <12 hours postoperatively, >12 hours postoperatively) in intravenous drug users (IVDU) undergoing cardiac valvular surgery.

Methods: Retrospective chart review of the electronic medical record. Data was collected from a single large rural academic medical center over a 14-month period. Patients with active or history of IV drug use who underwent cardiothoracic surgery and who received methadone intraoperatively were included in the analysis. Exclusion criteria included discharge less than 72 hours postoperatively, a documented allergy to methadone, and patients who were on oral methadone preoperatively. 61 patients received a single dose of IV methadone intraoperatively. 24 matched comparator patients did not receive any methadone. These 2 groups were compared on time to extubation using a Cochran-Mantel-Haenszel method to analyze the categorical data (intraoperative, <12 hours postoperatively, >12 hours postoperatively). Furthermore, groups were compared based on morphine equivalents intraoperatively and postoperatively, and the amount of anesthesia given intraoperatively and postoperatively by examining dexmedetomidine (intraoperative and postoperative) and ketamine requirements using Independent sample t-tests.

Measurements and main results: 91% of patients in the methadone group were extubated within 12 hours compared to 66% in the control group (p = 0.0006) demonstrating a significant linear association. There was no significant difference with regard to use of morphine equivalents, however, there was a significant difference in the dose of dexmedetomidine administered postoperatively between the methadone and control group (42.9 vs. 108, p = 0.039).

Conclusions: Administering a single dose of IV methadone intraoperatively in patients with an IV drug use history may facilitate earlier extubation and reduce postoperative sedation (dexmedetomidine) requirements.

Keywords: Early extubation; Early extubation after cardiac surgery; Intravenous drug users; Methadone; Opioid use; Pain control.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the West Virginia University Institutional Review Board with an IRB protocol number 1808254147. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

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