Year : 2013  |  Volume : 16  |  Issue : 1  |  Page : 28--39

Anesthesia for off-pump coronary artery bypass surgery

Thomas M Hemmerling1, Gianmarco Romano2, Nora Terrasini3, Nicolas Noiseux4 
1 Department of Anesthesia, McGill University, Montreal, Canada
2 Department of Anesthesia, University of Naples Federico II, Italy
3 Department of Anesthesia, University of Pisa, Pisa, Italy
4 Department of Cardiac Surgery, University of Montreal, Canada

Correspondence Address:
Thomas M Hemmerling
Department of Anesthesiology (McGill University), Montreal General Hospital, 1650 Cedar Avenue Montreal, H3G 1A4

The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB) surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

How to cite this article:
Hemmerling TM, Romano G, Terrasini N, Noiseux N. Anesthesia for off-pump coronary artery bypass surgery.Ann Card Anaesth 2013;16:28-39

How to cite this URL:
Hemmerling TM, Romano G, Terrasini N, Noiseux N. Anesthesia for off-pump coronary artery bypass surgery. Ann Card Anaesth [serial online] 2013 [cited 2021 Feb 25 ];16:28-39
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