Anesthesia for Minimally Invasive Coronary Artery Bypass Surgery.

IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Miranda Holmes, Alexander N J White, Luke J Rogers, Piroze M Davierwala
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Abstract

Minimally invasive coronary artery bypass grafting (MI-CABG) has emerged as a transformative approach to coronary revascularization, offering reduced morbidity, faster recovery and improved cosmesis compared to conventional coronary artery bypass grafting (CABG). Performed without full sternotomy and commonly without cardiopulmonary bypass (CPB), MI-CABG encompasses a variety of techniques. These procedures present unique challenges for the anesthesiologist, necessitating a tailored perioperative strategy. This review explores the anesthetic management of MI-CABG, focusing on preoperative assessment, intraoperative techniques, and postoperative care. Preoperative evaluation emphasizes cardiac, respiratory, and vascular considerations, including suitability for one-lung ventilation (OLV) and the impact of comorbidities. Intraoperatively, anesthesiologists must manage hemodynamic instability, ensure effective OLV, and maintain normothermia. Postoperative strategies prioritize multimodal analgesia, early extubation, and rapid mobilization to leverage the benefits of a minimally invasive approach. By integrating surgical and anesthetic perspectives, this review underscores the anesthesiologist's pivotal role in navigating the physiological demands of MI-CABG. As techniques evolve and experience grows, a comprehensive understanding of these principles will enhance the safety and efficacy of MI-CABG, making it a viable option for an expanding patient population.

微创冠状动脉搭桥手术的麻醉。
微创冠状动脉旁路移植术(MI-CABG)已成为冠状动脉血管重建术的一种变革性方法,与传统冠状动脉旁路移植术(CABG)相比,它具有降低发病率,更快恢复和改善外观的优点。MI-CABG无需全胸骨切开术,通常无需体外循环(CPB),包含多种技术。这些手术给麻醉师带来了独特的挑战,需要一个量身定制的围手术期策略。本文综述了MI-CABG的麻醉管理,重点是术前评估、术中技术和术后护理。术前评估强调心脏、呼吸和血管方面的考虑,包括单肺通气(OLV)的适用性和合并症的影响。术中,麻醉师必须控制血流动力学不稳定,确保有效的OLV,并维持正常体温。术后策略优先考虑多模式镇痛,早期拔管和快速动员,以充分利用微创入路的好处。通过整合外科和麻醉的观点,本综述强调了麻醉师在引导MI-CABG的生理需求方面的关键作用。随着技术的发展和经验的增长,对这些原则的全面理解将提高MI-CABG的安全性和有效性,使其成为扩大患者群体的可行选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Cardiovascular Development and Disease
Journal of Cardiovascular Development and Disease CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.60
自引率
12.50%
发文量
381
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