Difference between revisions of "Coronary artery bypass graft"
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|Cardiovascular | |Cardiovascular | ||
| | |Identify diseased vessels | ||
Note the EF | |||
All antianginal medications should be given day of surgery | |||
|- | |- | ||
|Pulmonary | |Pulmonary | ||
| Line 44: | Line 47: | ||
=== Labs and studies === | === Labs and studies === | ||
* CBC, CMP | |||
* PT, PTT | |||
* CXR: to evaluate for abnormalities (cardiomegaly, pleural effusions) | |||
* EKG: check for LBBB. If a PA catheter is planned, occasionally patients with LBBB may develop a third degree block as a consequence of PA catheter placement | |||
=== Operating room setup === | === Operating room setup === | ||
* Have at least 5-8 channels for infusions | |||
** Epi, norepi, carrier, insulin | |||
** Consider ketamine, precedex, ancef | |||
* Drugs: | |||
** Heparin, protamine, calcium | |||
* Perfusion technician should be available | |||
* Fluid warmer | |||
* Triple transducers primed and zeroed | |||
* Internal defibrillator/pacer available in room | |||
* TEE machine with appropriately sized probe | |||
=== Patient preparation and premedication === | === Patient preparation and premedication === | ||
* All cardiac medications should be continued on day of surgery except ACE inhibitors which should be stopped 24h prior to surgery | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
Revision as of 09:46, 14 March 2022
| Anesthesia type | |
|---|---|
| Airway | |
| Lines and access | |
| Monitors | |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Coronary Artery Bypass Graft, also known as CABG, is a common cardiac surgery procedure in which vein or artery is used as a conduit and is either grafted from the aorta (or if using left internal mammary artery, used in situ) to a coronary artery beyond a blockage in the vessel, with goal of improving blood flow to the heart, i.e. surgical coronary re-vascularization. The left internal mammary artery (LIMA) is considered first choice of graft due to high patency rate of > 90% at 10 years, though saphenous vein grafts are often used as well. It is most often indicated for individuals with significant multi-vessel Coronary Artery Disease, in particular those with Diabetes Mellitus or left main coronary vessel disease; it can also be used on a more emergent basis for those with Acute Coronary Syndrome and ST-Elevation Myocardial Infarction cases that are refractory to PCI or maximal medical management. It can be described by the number of vessels to be bypassed (single, double, triple, quadruple) as well as the technique (traditional on-pump, off-pump or minimally invasive direct).
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | Identify diseased vessels
Note the EF All antianginal medications should be given day of surgery |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
- CBC, CMP
- PT, PTT
- CXR: to evaluate for abnormalities (cardiomegaly, pleural effusions)
- EKG: check for LBBB. If a PA catheter is planned, occasionally patients with LBBB may develop a third degree block as a consequence of PA catheter placement
Operating room setup
- Have at least 5-8 channels for infusions
- Epi, norepi, carrier, insulin
- Consider ketamine, precedex, ancef
- Drugs:
- Heparin, protamine, calcium
- Perfusion technician should be available
- Fluid warmer
- Triple transducers primed and zeroed
- Internal defibrillator/pacer available in room
- TEE machine with appropriately sized probe
Patient preparation and premedication
- All cardiac medications should be continued on day of surgery except ACE inhibitors which should be stopped 24h prior to surgery
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |