Difference between revisions of "Off-pump and minimally invasive coronary artery bypass grafting"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General +/- epidural | ||
| airway = | | airway = DLT, L sided | ||
| lines_access = | | lines_access = Large bore PIVs, central line, arterial line | ||
| monitors = | | monitors = Standard, 5-Lead ECG, arterial line, +/- TEE | ||
| considerations_preoperative = | | considerations_preoperative = Known coronary artery disease | ||
| considerations_intraoperative = | | considerations_intraoperative = DLT, ischemic preconditioning, temporary occlusion | ||
| considerations_postoperative = | | considerations_postoperative = Pain control | ||
}} | }} | ||
Off pump and minimally invasive coronary artery bypass grafting is a surgical technique that allows for coronary revascularization without the use of cardiopulmonary bypass. The ideal candidate for this technique is hemodynamically stable, normal EF, no previous cardiac surgery, no history of severe pulmonary conditions, and non-obese<ref>{{Cite journal|last=Patel|first=Amit N.|last2=Benetti|first2=Federico|last3=Hamman|first3=Baron|date=2003-07|title=Patient Selection and Technical Considerations for Off-Pump Coronary Surgery|url=https://www.tandfonline.com/doi/full/10.1080/08998280.2003.11927916|journal=Baylor University Medical Center Proceedings|language=en|volume=16|issue=3|pages=291–293|doi=10.1080/08998280.2003.11927916|issn=0899-8280}}</ref><ref>{{Cite book|last=Jaffe|first=Richard|title=Anesthesiologist's Manual of Surgical Procedures|publisher=Wolters Kluwer|year=2014|isbn=978-1-4511-7660-5}}</ref>. 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<ref>{{Cite journal|last=Shroyer|first=A. Laurie|last2=Grover|first2=Frederick L.|last3=Hattler|first3=Brack|last4=Collins|first4=Joseph F.|last5=McDonald|first5=Gerald O.|last6=Kozora|first6=Elizabeth|last7=Lucke|first7=John C.|last8=Baltz|first8=Janet H.|last9=Novitzky|first9=Dimitri|date=2009-11-05|title=On-Pump versus Off-Pump Coronary-Artery Bypass Surgery|url=http://www.nejm.org/doi/abs/10.1056/NEJMoa0902905|journal=New England Journal of Medicine|language=en|volume=361|issue=19|pages=1827–1837|doi=10.1056/NEJMoa0902905|issn=0028-4793}}</ref><ref>{{Cite journal|last=Hemmerling|first=ThomasM|last2=Romano|first2=Gianmarco|last3=Terrasini|first3=Nora|last4=Noiseux|first4=Nicolas|date=2013|title=Anesthesia for off-pump coronary artery bypass surgery|url=https://journals.lww.com/10.4103/0971-9784.105367|journal=Annals of Cardiac Anaesthesia|language=en|volume=16|issue=1|pages=28|doi=10.4103/0971-9784.105367|issn=0971-9784}}</ref>. | |||
== Preoperative management == | ==Preoperative management== | ||
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> === | ===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->=== | ||
{| class="wikitable" | {| class="wikitable" | ||
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!Considerations | !Considerations | ||
|- | |- | ||
|Neurologic | |Neurologic | ||
| | | | ||
|- | |- | ||
|Cardiovascular | | Cardiovascular | ||
| | | | ||
|- | |- | ||
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|Other | | Other | ||
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->=== | ||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->=== | ||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. 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. --> === | ===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. -->=== | ||
== Intraoperative management == | ==Intraoperative management== | ||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->=== | ||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->=== | ||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->=== | ||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->=== | ||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->=== | ||
== Postoperative management == | ==Postoperative management == | ||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | ===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->== | ||
{| class="wikitable wikitable-horizontal-scroll" | {| class="wikitable wikitable-horizontal-scroll" | ||
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|} | |} | ||
== References == | ==References== | ||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
Revision as of 14:47, 16 August 2023
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 | |
| User likes | 0 |
Off pump and minimally invasive coronary artery bypass grafting is a surgical technique that allows for coronary revascularization without the use of cardiopulmonary bypass. The ideal candidate for this technique is hemodynamically stable, normal EF, 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
- ↑ 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) - ↑ Jaffe, Richard (2014). Anesthesiologist's Manual of Surgical Procedures. Wolters Kluwer. ISBN 978-1-4511-7660-5.
- ↑ 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.
- ↑ 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.
Top contributors: Mitchel DeVita, Gang Chen and Chris Rishel