Complete myocardial revascularization on the beating heart with epicardialstabilization: Anesthetic considerations

Objective: To describe an anesthetic management protocol for patients under going cardiac surgery with multiple coronary artery bypass grafts without c ardiopulmonary bypass (off-pump CABG surgery) by median sternotomy with mec hanical stabilization. Design: Retrospective nonrandomized analysis. Setting: Tertiary care hospital. Participants: Sixty-six consecutive patients on whom off-pump CABG surgery by median sternotomy was attempted. Interventions: Anesthesia was induced with a combination of etomidate and f entanyl; pancuronium bromide was given for muscle relaxation; and anesthesi a was maintained with isoflurane, desflurane, or sevoflurane in 100% oxygen . Maintenance of normothermia was attempted by keeping the room temperature at 70 degrees F, warming all fluids to 41 degrees C, and using 2.5 L/min o f fresh gas flows and a heat and humidity exchanger. When available, a conv ective forced-air blanket was used to cover patients' head and shoulders. P atients who were not slated for revascularization of the circumflex vessels and who had good ventricular function received central venous pressure mon itoring (26%); all other patients received a pulmonary artery catheter. Measurements and Main Results: Of the 66 patients, 36% required an epinephr ine infusion at a mean rate of 1.45 +/- 2.05 mu g/min intraoperatively to m aintain hemodynamic stability; 25% required inotropic support for < 12 hour s in the intensive care unit. Conclusion: Institution of systematic hemodynamic management was associated with the successful completion of the surgical procedure in 61 patients (9 2%), Only 5 patients required conversion to regular CABG surgery with cardi opulmonary bypass. Copyrights 2000 by W.B. Saunders Company.