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 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
- ↑ 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.
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