The use of morphine derivatives is widespread for performing general anesthesia. However,
opioids have their own side effects: respiratory depression, digestive ileus, cognitive
dysfunction, postoperative hyperalgesia, nausea-vomiting or even negative effects on
inflammation or adrenal function. The advent of new molecules, with analgesic properties that
do not pass through opioid receptors, has allowed the emergence of the concept of anesthesia
without morphine (opioid free anesthesia OFA). These molecules are essentially:
dexmedetomidine, ketamine, lidocaine. Thus, the use of ketamine is currently recommended in
the event of major surgery in order to limit postoperative pain and hyperalgesia. Likewise,
the use of dexmedetomidine in place of an opioid during bariatric surgeries has been shown to
reduce postoperative pain and intraoperative hemodynamic manifestations. In addition, it
would also reduce the incidence of postoperative cognitive dysfunction. A recent
meta-analysis even suggested a decrease in length of stay, mechanical ventilation, atrial
fibrillation and mortality with the use of dexmedetomidine in the perioperative period. The
combined use of various non-morphine analgesic molecules therefore opens the way to
anesthesia without morphine, and a French multicenter study on this strategy in general
non-cardiac surgery is currently underway. Cardiac surgery is characterized by significant
postoperative pain, a high incidence of cognitive dysfunction, and frequent and sometimes
significant respiratory complications. An OFA strategy could therefore be beneficial to these
patients, but no study has yet addressed the subject.