Embracing the heart: perioperative management of patients undergoing off-pump coronary artery bypass grafting using the octopus tissue stabilizer.
OBJECTIVE
To describe hemodynamic alterations during coronary artery bypass grafting (CABG) without extracorporeal circulation using the Octopus Tissue Stabilizer, and to describe the two anesthetic management protocols based on either general anesthesia with opioids (34 patients) or general anesthesia with high thoracic epidural anesthesia (TEA; 66 patients).


METHODS
A prospective observational report.


METHODS
An academic university heart center.


METHODS
First 100 patients undergoing CABG using the Octopus Tissue Stabilizer.


METHODS
None.


RESULTS
Current management provided satisfactory results in preventing hypoperfusion of the heart and inadequate systemic circulation without the use of major pharmacologic interventions. Movement of the heart to reach the target site of anastomosis caused hemodynamic alterations. These could easily be corrected by anesthetic interventions, such as fluid load and low doses of inotropes. High TEA allows earlier extubation compared with the opioid anesthesia technique (0.9 v 4.5 hours). Perioperative management and the incidence of postoperative complications did not differ between anesthetic techniques. Major complications, such as death, intraoperative myocardial infarction, and stroke, did not occur.


CONCLUSIONS
Both anesthetic protocols are safe and effective in handling these patients. Off-pump CABG surgery requires anesthetic interventions because hemodynamic alterations are caused by the presentation of the heart to the surgeon. The complication rate is low but needs to be evaluated, compared with conventional CABG, in a prospective randomized study. High thoracic epidural anesthesia allows early recovery, but improved outcome could not be proved in this patient group.
Nierich
A P
AP
Department of Anesthesiology, The Heart-Lung Institute of Utrecht, University Hospital of Utrecht, The Netherlands.
Diephuis
J
J
Jansen
E W
EW
van Dijk
D
D
Lahpor
J R
JR
Borst
C
C
Knape
J T
JT
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000714:Anastomosis, Surgical; D000767:Anesthesia, Epidural / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology; D004867:Equipment Design; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D009200:Myocardial Contraction / Q000187:drug effects / Q000502:physiology; D009294:Narcotics / Q000008:administration & dosage; D011446:Prospective Studies; D012449:Safety; D013396:Suction / Q000295:instrumentation*; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D009294:Narcotics