Off-pump and minimally invasive coronary artery bypass grafting

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Off-pump and minimally invasive coronary artery bypass grafting
Anesthesia type

General +/- epidural

Airway

DLT, L sided

Lines and access

Large bore PIVs, central line, arterial line

Monitors

Standard, 5-Lead ECG, arterial line, +/- TEE

Primary anesthetic considerations
Preoperative

Known coronary artery disease

Intraoperative

DLT, ischemic preconditioning, temporary occlusion

Postoperative

Pain control

Article quality
Editor rating
Unrated
User likes
0

Off pump coronary artery bypass grafting is a term that applies to all cases of coronary revascularization without the need of cardiopulmonary bypass. Minimally invasive coronary artery bypass grafting is a sub-type of off pump coronary artery bypass that is performed through a small thoracotomy incision. The ideal candidate for this technique is hemodynamically stable, normal ejection fraction, no previous cardiac surgery, no history of severe pulmonary conditions, and non-obese[1][2]. In the mid-1990s, this technique gained interest as a way to avoid the postoperative complications associated with cardiopulmonary bypass including systemic inflammatory response, cerebral dysfunction, renal dysfunction, bleeding, myocardial depression, and hemodynamic instability[3][4].

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

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

References

  1. Patel, Amit N.; Benetti, Federico; Hamman, Baron (2003-07). "Patient Selection and Technical Considerations for Off-Pump Coronary Surgery". Baylor University Medical Center Proceedings. 16 (3): 291–293. doi:10.1080/08998280.2003.11927916. ISSN 0899-8280. Check date values in: |date= (help)
  2. Jaffe, Richard (2014). Anesthesiologist's Manual of Surgical Procedures. Wolters Kluwer. ISBN 978-1-4511-7660-5.
  3. Shroyer, A. Laurie; Grover, Frederick L.; Hattler, Brack; Collins, Joseph F.; McDonald, Gerald O.; Kozora, Elizabeth; Lucke, John C.; Baltz, Janet H.; Novitzky, Dimitri (2009-11-05). "On-Pump versus Off-Pump Coronary-Artery Bypass Surgery". New England Journal of Medicine. 361 (19): 1827–1837. doi:10.1056/NEJMoa0902905. ISSN 0028-4793.
  4. Hemmerling, ThomasM; Romano, Gianmarco; Terrasini, Nora; Noiseux, Nicolas (2013). "Anesthesia for off-pump coronary artery bypass surgery". Annals of Cardiac Anaesthesia. 16 (1): 28. doi:10.4103/0971-9784.105367. ISSN 0971-9784.