Off-pump coronary artery bypass surgery: physiology and anaesthetic management

Details

Serval ID
serval:BIB_9516F49D36D5
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Off-pump coronary artery bypass surgery: physiology and anaesthetic management
Journal
British Journal of Anaesthesia
Author(s)
Chassot  P. G., van der Linden  P., Zaugg  M., Mueller  X. M., Spahn  D. R.
ISSN
0007-0912 (Print)
Publication state
Published
Issued date
03/2004
Volume
92
Number
3
Pages
400-13
Notes
Journal Article
Review --- Old month value: Mar
Abstract
Increasing interest is being shown in beating heart (off-pump) coronary artery surgery (OPCAB) because, compared with operations performed with cardiopulmonary bypass, OPCAB surgery may be associated with decreased postoperative morbidity and reduced total costs. Its appears to produce better results than conventional surgery in high-risk patient populations, elderly patients, and those with compromised cardiac function or coagulation disorders. Recent improvements in the technique have resulted in the possibility of multiple-vessel grafting in all coronary territories, with a graft patency comparable with conventional surgery. During beating-heart surgery, anaesthetists face two problems: first, the maintenance of haemodynamic stability during heart enucleation necessary for accessing each coronary artery; and second, the management of intraoperative myocardial ischaemia when coronary flow must be interrupted during grafting. The anaesthetic technique is less important than adequate management of these two major constraints. However, experimental and recent clinical data suggest that volatile anaesthetics have a marked cardioprotective effect against ischaemia, and might be specifically indicated. OPCAB surgery requires team work between anaesthetists and surgeons, who must be aware of each other's constraints. Some surgical aspects of the operation are reviewed along with physiological and anaesthetic data.
Keywords
Anesthesia, General/*methods Cardiopulmonary Bypass/adverse effects Coronary Artery Bypass/adverse effects/*methods Hemodynamic Processes Humans Intraoperative Care/methods Myocardial Ischemia/prevention & control
Pubmed
Web of science
Create date
28/01/2008 11:43
Last modification date
20/08/2019 15:57
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