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Anaesthesia for off-pump coronary artery bypass grafting surgery

Abstract
Coronary artery bypass grafting (CABG) surgery may be undertaken with or without cardiopulmonary bypass (CPB) that is on- or off-pump. Although off-pump has a slightly higher mortality, it associated with a
lower incidences of short-term complications, compared with on-pump CABG surgery favouring enhanced recovery. High-dose opioid techniques of general anaesthesia should be avoided and either inhalation or total intravenous (IV) anaesthesia may be used. Monitoring should include a five-lead lectrocardiograph and invasive systemic arterial pressure measurement. Effective communication between anaesthetist and surgeon is essential. Maintenance of diastolic arterial pressure (DAP) underpins prevention of myocardial ischaemia and cardiovascular collapse. Surgical positioning of the heart so as to minimize hypotension is paramount and IV fluid loading or vasoconstrictors and positive inotropes are effective. Correction of bradycardia with atropine 0.3 mg IV or epicardial pacing also helps to maintain DAP. Persisting hypotension requires intraaortic balloon pumping or conversion to on-pump CABG surgery. As there is less blood loss, minimal requirement for cardiovascular support and earlier recovery of consciousness associated with off- compared with on-pump CABG surgery, patients may be managed in a recovery room then transferred to a high-dependency unit, thus bypassing ICU.

Keywords Cardiopulmonary bypass; coronary artery bypass grafting; coronary artery disease; epidural analgesia; general anaesthesia; hypotension; intra-operative monitoring; vasoconstrictor agents

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Informasi Detail
Judul Seri
ANAESTHESIA AND INTENSIVE CARE MEDICINE Volume 16:10 Oktober 2015
No. Panggil
-
Penerbit
: Elsevier Ltd.,
Deskripsi Fisik
ANAESTHESIA AND INTENSIVE CARE MEDICINE Volume 16:10 Oktober 2015
Bahasa
English
ISBN/ISSN
1472–0299
Klasifikasi
-
Tipe Isi
-
Tipe Media
-
Tipe Pembawa
-
Edisi
-
Subjek
ANASTESI
JANTUNG
Info Detail Spesifik
-
Pernyataan Tanggungjawab
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Tidak tersedia versi lain

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