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Intraoperative Management and Anesthesia

  • Yoshihiko OhnishiEmail author

Abstract

General anesthesia using continuous infusion of remifentanil and propofol (or inhalational anesthetic drug) is the most popular anesthetic technique during off-pump coronary artery bypass (OPCAB) surgery due to established early awareness and extubation. Maintain of peripheral temperature using a warming system and continuous infusion of vasodilator is also important. Monitoring of transesophageal echocardiography is essential to diagnose not only ventricular systolic function but also ventricular diastolic function in most patients. Measurement of pulmonary artery catheter including continuous monitoring of central venous oxygen saturation is more useful during OPCAB pulmonary surgery compared with conventional coronary artery bypass (on-pump CABG) surgery. During anastomosis of circumflex artery or right coronary artery, Trendelenburg position is effective to maintain venous return. Preoperative induction of intra-aortic balloon pumping is effective for patients with acute coronary syndrome or severe heart failure. In patients with severe mitral regurgitation or low diastolic function, it is important to determine elective conversion to on-pump CABG.

Keywords

Anesthesia Transesophageal echocardiography Pulmonary artery catheter Diastolic function Intra-aortic balloon pumping 

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Copyright information

© Springer Japan 2016

Authors and Affiliations

  1. 1.Department of AnesthesiologyNational Cerebral and Cardiovascular CenterSuitaJapan

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