[Anesthetic management of combined lung volume reduction surgery and off-pump coronary artery bypass grafting].
A 54-year-old man with severe emphysema and stenosis of coronary artery was scheduled for combined surgery of lung volume reduction and an off-pump coronary artery bypass grafting. His FEV1.0 was 600 ml and %FEV1.0 was 18%. Coronary angiography showed 99% stenosis of the left anterior descending artery. Anesthesia was induced with propofol, fentanyl and vecuronium, and was maintained with sevoflurane and continuous epidural anesthesia. In order to avoid high airway pressure, a pressure-controlled ventilation (less than 15 cmH2O) was carried out. A laryngeal mask airway was replaced with an endotracheal tube after surgery to avoid bucking during extubation, and this was removed after recovery from anesthesia successfully. No complications were observed during anesthesia. Lung volume reduction surgery after coronary reconstruction by off-pump coronary artery bypass grafting may be beneficial for patients with emphysema and ischemic heart disease.
Maeda
Yoshinori
Y
Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Saga University.
Ueda
Naoyuki
N
Ueda
Hiroko
H
Mitsumizo
Shinji
S
Nakashima
Mikio
M
Totoki
Tadahide
T
D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000150:complications / Q000601:surgery; D012720:Severity of Illness Index