Anesthetic management, pain, and oxidative stress during urgent PCI in patients with STEMI

ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring urgent restoration of coronary blood flow. Urgent percutaneous coronary intervention (PCI) remains the principal reperfusion strategy; however, ischemia, reperfusion, and the invasive procedure itself are associated with pronounced pain and activation of oxidative stress. The anesthetic management strategy may influence both pain intensity and the course of ischemia-reperfusion injury. Materials and methods. This single-center prospective comparative study included 90 patients with STEMI who underwent urgent PCI in 2020–2024. Patients were allocated to three groups according to anesthetic management. Group I received standard analgosedation with sibazone and fentanyl. Group II received multimodal low-opioid anesthesia with fentanyl, propofol, paracetamol, and lidocaine. Group III received the same regimen combined with intravenous edaravone. Pain intensity was assessed using the Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS) at baseline, during stenting and reperfusion, and in the early postoperative period. Malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) levels were measured at the beginning and at the end of the procedure. Results. At baseline, the groups were statistically homogeneous in terms of pain intensity and oxidative stress markers. During stenting and reperfusion, pain intensity in Groups II and III was significantly lower than in Group I both on the NRS (p=0.0012) and VAS (p=0.0009). In the early postoperative period, intergroup differences in pain intensity did not reach statistical significance. By the end of the intervention, all groups demonstrated an increase in MDA, a decrease in SOD activity, and an increase in GPx, reflecting ischemia-reperfusion oxidative stress. The most unfavorable dynamics were observed in Group I, whereas Group III showed the least pronounced changes. Statistically significant intergroup differences at the end of the procedure were found for SOD (p=0.031), with a significant difference between Groups I and III. Conclusions. Multimodal anesthetic regimens in patients with STEMI undergoing urgent PCI provided better control of intraoperative pain than standard analgosedation. The most favorable oxidative stress profile was observed when multimodal low-opioid anesthesia was combined with edaravone, suggesting better preservation of antioxidant defense during ischemia-reperfusion.

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