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Off-pump coronary bypass grafting in a post-pneumonectomy patient: Challenges and management


1 Department of Cardiac Anaesthesia, Fortis Memorial Research Institute, Gurgaon, Haryana, India
2 Department of CTVS, Fortis Memorial Research Institute, Gurgaon, Haryana, India

Correspondence Address:
Vishal Jain
Department of Cardiac Anaesthesia, Fortis Memorial Research Institute, Sector-44, Gurgaon - 122 001, SHaryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_37_18

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Year : 2019  |  Volume : 22  |  Issue : 1  |  Page : 86-88

 

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Pulmonary complications are common in cardiac surgical patients. Limited respiratory reserves along with the pain associated with sternotomy add to the morbidity. Patients undergoing cardiac surgery who have had a pneumonectomy done before can be even more challenging to manage perioperatively due to a single-functioning lung. We present a case of a postpneumonectomy patient who underwent off-pump coronary artery bypass grafting. Perioperative optimization of lung function tests was stressed upon including the chest physiotherapy and early mobilization. Preoperative thoracic epidural catheter was inserted for postoperative pain and other proven benefits of thoracic epidural in coronary artery disease patients. We could conclude from our experience that proper optimization of lung function tests and meticulous pain management along with fast-tracking are keys to the management of such patients.






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1 Department of Cardiac Anaesthesia, Fortis Memorial Research Institute, Gurgaon, Haryana, India
2 Department of CTVS, Fortis Memorial Research Institute, Gurgaon, Haryana, India

Correspondence Address:
Vishal Jain
Department of Cardiac Anaesthesia, Fortis Memorial Research Institute, Sector-44, Gurgaon - 122 001, SHaryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_37_18

Rights and Permissions

Pulmonary complications are common in cardiac surgical patients. Limited respiratory reserves along with the pain associated with sternotomy add to the morbidity. Patients undergoing cardiac surgery who have had a pneumonectomy done before can be even more challenging to manage perioperatively due to a single-functioning lung. We present a case of a postpneumonectomy patient who underwent off-pump coronary artery bypass grafting. Perioperative optimization of lung function tests was stressed upon including the chest physiotherapy and early mobilization. Preoperative thoracic epidural catheter was inserted for postoperative pain and other proven benefits of thoracic epidural in coronary artery disease patients. We could conclude from our experience that proper optimization of lung function tests and meticulous pain management along with fast-tracking are keys to the management of such patients.






[FULL TEXT] [PDF]*


        
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