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Anaesthesia for off-pump coronary artery bypass grafting 

Anaesthesia for off-pump coronary artery bypass grafting
Chapter:
Anaesthesia for off-pump coronary artery bypass grafting
Author(s):

Yatin Mehta

and Madhur Malik

DOI:
10.1093/med/9780199653478.003.0020
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date: 20 October 2019

Despite the large increase in numbers of percutaneous coronary interventions, rates of coronary artery bypass graft (CABG) surgery are increasing around the world. Cardiopulmonary bypass (CPB) increases coagulopathy and bleeding, re-exploration, systemic inflammatory response syndrome, and possibly neurocognitive dysfunction and stroke. Off-pump CABG surgery (OPCAB) has evolved over the last two decades with the aim of reducing complications. OPCAB is technically more demanding than conventional CABG (cCABG) and also requires special instruments in order to accomplish coronary anastomosis on a moving target without significantly compromising haemodynamics. The anaesthetic goals during OPCAB include maintenance of stable haemodynamics by preload augmentation, poisitive inotropes and/or vasopressors and positioning of the patient. Good postoperative analgesia may include regional analgesic techniques such as thoracic epidural analgesia, intrathecal opioids, or paravertebral block so facilitating comfort and early mobilization and discharge. OPCAB has been shown to have equally good results as cCABG with reduced morbidity but not necessarily mortality.

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