Anesthetic considerations for coronary artery surgery

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Anesthetic considerations for coronary artery surgery encompass a wide range of important details, all of which have as an end the reduction of perioperative myocardial injury.1–6 We believe that with the advances made in the past decade every patient should leave the operating room with a better functioning heart, and the challenge to the anesthesiologist is to bring the patient safely to that point in the operation when the surgeon arrests and repairs the heart.

We consider the single greatest advance in this field to be the introduction of cold crystalloid potassium cardioplegia.7 It has reduced our perioperative transmural infarction rate from 20.8% to 4% and it is clear to us that this reduction has been entirely due to the use of cardioplegic arrest of the heart.

Anyone discussing coronary artery disease inevitably analyzes those factors that affect the crucial balance between the oxygen supply and demands of the myocardium. I will not critically evaluate each factor that, in one way or another, can affect this balance as this will be discussed elsewhere. I do emphasize, however, that maintaining this critical oxygen balance is the single most important factor that the anesthesiologist may control and that will affect the successful outcome of surgery. The purpose of this paper is to emphasize those factors that we believe are important if we are to provide the patient with a maximal opportunity for a successful operation.

Preoperative assessment

The factors that we consider important begin with the preoperative evaluation of the patient, . . .



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