Anesthetic management of patients undergoing coronary artery bypass grafting with the use of an axial flow pump and a short-acting beta-blocker.
OBJECTIVE
To describe the clinical protocol regarding monitoring, pharmacologic interventions, and postoperative care during and after coronary artery bypass grafting (CABG) on the beating heart with an axial flow pump and a short-acting beta-blocker.


METHODS
A retrospective study.


METHODS
A university hospital.


METHODS
Seventeen patients scheduled for elective CABG.


METHODS
Invasive monitoring was performed with either a standard pulmonary artery catheter (PAC) or a surgically placed PAC. An axial flow pump was inserted through a graft sutured to the ascending aorta. A short-acting beta-blocker was administered to decrease the motion of the heart and make conditions for CABG adequate and safe.


RESULTS
Compared with baseline measurements, there were significant decreases in mean arterial blood pressure, mixed venous oxygen saturation, and right ventricular ejection fraction during maximal axial flow pump support and beta-blockade. No significant change in heart rate was observed at this time. Hemodynamic variables were normalized in the intensive care unit. All patients were separated from the Hemopump without inotropic support, and values of troponin-T, aspartate aminotransferase, and alanine aminotransferase were low postoperatively. All patients survived and were discharged from the hospital.


CONCLUSIONS
The anesthetic protocol for patients undergoing surgery with a beating heart and the combined use of an axial flow pump and a short-acting beta-blocker is outlined. Multiple-vessel CABG on the beating heart was performed with maintenance of an acceptable hemodynamic situation.
Peterzén
B
B
Linköping Heart Center and Department of Medical Informatics, University of Linköping, Sweden.
Lönn
U
U
Babi'c
A
A
Carnstam
B
B
Rutberg
H
H
Casimir-Ahn
H
H
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D001794:Blood Pressure; D002302:Cardiac Output; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006339:Heart Rate; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011412:Propanolamines / Q000008:administration & dosage*; D012189:Retrospective Studies; D014655:Vascular Resistance
D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C036604:esmolol; D010100:Oxygen