An Inhalation Anesthetic Technique is Preferable for Patients Undergoing Coronary Artery Bypass Grafting

Abstract

What is the “best” method for anesthetizing patients for coronary artery bypass graft (CABG) surgery? Is there a “best” method? The very low morbidity and mortality reported from many centers where different anesthetics are employed [1] would suggest that there is no ideal technique. Nevertheless, it appears that the reflex response of many anesthesiologists when confronted with a patient for CABG (or for that matter any patient with “severe” heart disease) is to reach for one of the potent intravenous narcotics. To give these drugs their due, the current popularity of high-dose narcotic techniques for CABG is, no doubt, based upon their safety, the “railroad track” hemodynamics [2, 3] that often accompany their administration, and their ease of use. In many centers, volatile anesthetics have been relegated to the occasional role of treating a bit of hypertension here and there. We feel this is simplistic, inappropriate, makes little use of the beneficial properties of the vapors, and is incredibly boring. Therefore the aim of this chapter is to discuss the rationale for selecting a volatile agent as the primary anesthetic for CABG patients. We hope to encourage the intelligent use of volatile drugs by describing their safety and efficacy in patients with coronary artery disease as well as delineating potential problems or difficulties with their use.