This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Ganapathy, S. Articles by Boyd, W. D. Search for Related Content PubMed Articles by Ganapathy, S. Articles by Boyd, W. D. Social Bookmarking                         What's this?

Anesthesia and Regional Anesthetic Techniques for Minimally Invasive Direct Coronary Artery Bypass Surgery

Department of Anesthesia, University of Western Ontario

Wojciech Dobkowski

Department of Anesthesia, University of Western Ontario

John M. Murkin

Department of Anesthesia, University of Western Ontario

Walter D. Boyd

Department of Cardiovascular Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada

An innovative new approach to coronary revasculariza tion, minimally invasive direct coronary artery bypass is performed via a small anterior minithoracotomy or ministernotomy on a beating heart without the aid of cardiopulmonary bypass. Components of this tech nique, including thoracoscopic video-assisted harvest ing of the internal mammary artery, often with har monic scalpel and potentially even robotic assistance, necessitate prolonged one-lung ventilation. In the ab sence of cardioplegia, myocardial protection during normothermic beating heart surgery poses a challenge. Patient selection is important to avoid intraoperative and postoperative complications. Prolonged single- lung ventilation, incomplete revascularization in hybrid procedures, and limited access for rapid intervention pose challenges with patient management. Conversion to sternotomy may be required in 5% to 7% of patients, and extension of portals over several dermatomal seg ments mandate a versatile analgesic technique. Re gional anesthesia as analgesic adjuvant allows lighter levels of general anesthesia during surgery with mini mal intraoperative hemodynamic changes and a smooth transition to postoperative analgesia. Although a num ber of regional techniques may be used to achieve this goal, thoracic epidural analgesia or continuous percuta neous paravertebral block seem to offer specific advan tages of cardiac sympathectomy.

Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 4, No. 2, 92-102 (2000)
DOI: 10.1053/vc.2000.6500


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?