scholarly journals Dexmedetomidine as a Heart Rate Control for Off-Pump Coronary Artery Bypass Surgery

2021 ◽  
Author(s):  
Doddy Tavianto ◽  
Reza W Sudjud ◽  
Budiana Rismawan ◽  
M Budi Kurniawan ◽  
Hana Nur R ◽  
...  
Keyword(s):  
Heart Rate ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Beta Blocker ◽  
Artery Bypass ◽  
Off Pump ◽  
Coronary Arterial Disease ◽  
Surgery Patient ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

Introduction: The traditional surgical approach is performed under cardiac arrest with cardiopulmonary bypass (CPB), which has the potential to result in myocardial injuries. In 1990s, when researchers developed efficient mechanical stabilizer devices, Off-pump coronary artery bypass (OPCAB) gained more widespread interest, as it’s associated with many significant benefits. Avoidance of tachycardia is a goal for anesthetic management during OPCAB surgery. A short-acting Beta-blocker is needed for lowering excessive increases in heart rate. However, in some hospitals these drugs were not available. Case: A 53-yr-old, 73 kg man with a three-vessel coronary arterial disease with left main disease was scheduled for elective OPCAB surgery. Patient has a medical history of heart attack and hypertension. Preoperative echocardiography shows reduced LV systolic function, diastolic dysfunction grade I, with LVEF 47%. Throughout the hour after induction, HR increased in a constant manner to a persistent of 85-90 bpm despite additional fentanyl given. We didn’t have any intravenous beta blocker drug and therefore we started dexmedetomidine. HR decreased to 55-60 bpm and remained at that value throughout the surgical procedure. Patient extubated in OR and transferred to ICU. After 6 days, he was discharged from the hospital without any complications. Conclusion: Perioperative administration of Dexmedetomidine is an effective adjuvant to general anaesthesia, attenuates the stress response to intubation, provides minimal heart rate variations, enabling smooth extubation, also provides adequate sedation in the post-operative period.

scholarly journals Dexmedetomidine as a Heart Rate Control for Off-Pump Coronary Artery Bypass Surgery

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Doddy Tavianto ◽  
◽  
Reza W Sudjud ◽  
Budiana Rismawan ◽  
M Budi Kurniawan ◽  
...  
Keyword(s):  
Heart Rate ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Beta Blocker ◽  
Artery Bypass ◽  
Off Pump ◽  
Coronary Arterial Disease ◽  
Surgery Patient ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

Introduction: The traditional surgical approach is performed under cardiac arrest with cardiopulmonary bypass (CPB), which has the potential to result in myocardial injuries. In 1990s, when researchers developed efficient mechanical stabilizer devices, Off-pump coronary artery bypass (OPCAB) gained more widespread interest, as it’s associated with many significant benefits. Avoidance of tachycardia is a goal for anesthetic management during OPCAB surgery. A short-acting Beta-blocker is needed for lowering excessive increases in heart rate. However, in some hospitals these drugs were not available. Case: A 53-yr-old, 73 kg man with a three-vessel coronary arterial disease with left main disease was scheduled for elective OPCAB surgery. Patient has a medical history of heart attack and hypertension. Preoperative echocardiography shows reduced LV systolic function, diastolic dysfunction grade I, with LVEF 47%. Throughout the hour after induction, HR increased in a constant manner to a persistent of 85-90 bpm despite additional fentanyl given. We didn’t have any intravenous beta blocker drug and therefore we started dexmedetomidine. HR decreased to 55-60 bpm and remained at that value throughout the surgical procedure. Patient extubated in OR and transferred to ICU. After 6 days, he was discharged from the hospital without any complications. Conclusion: Perioperative administration of Dexmedetomidine is an effective adjuvant to general anaesthesia, attenuates the stress response to intubation, provides minimal heart rate variations, enabling smooth extubation, also provides adequate sedation in the post-operative period.

scholarly journals Outcome of off-pump coronary artery bypass graft (OPCAB) surgery: Analysis of 129 cases

2016 ◽  
Vol 31 (1) ◽  
pp. 23-25
Author(s):  
AKM Manzurul Alam ◽  
Istiaq Ahmed ◽  
Manzil Ahmed ◽  
Al Mamun Hossain
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Off Pump ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, including Bangladesh. Besides medical and interventional treatment, coronary artery bypass graft (CABG) surgery in an effective modality for the management of a subset of CAD patients. Off-pump coronary artery bypass graft (OPCAB) surgery is a recent modification of conventional CABG surgery, which, like other parts of the world, is being increasingly practiced in Bangladesh. But the outcome of this relatively recent surgical approach in our setting is largely unknown. In this study, the outcomes of 129 cases off-pump CABG surgery done in a tertiary cardiovascular centre and a private institute in Dhaka were analyzed. Majority (67, 54.2%) had triple vessel disease (TVD), while 4 (3.2%) patients had left main disease. One, two and three grafts were used in 17 (13.2%),74 (57.4%) and 38 (29.4%) cases respectively. There was no mortality. Post-operative complications occurred in 17 (13.18%) patients; secondary wound infection in 10 (7.75%) and immediate respiratory distress in 7 (5.43%) cases. Ten (7.75%) patients needed secondary stitches.Bangladesh Heart Journal 2016; 31(1) : 23-25

A Comparison of Success Rate in Off-Pump Coronary Artery Bypass Grafting Surgery among Patients with Varying Preoperative Left Ventricular Ejection Fractions: Retrospective Observational Study

2021 ◽  
Vol 104 (8) ◽  
pp. 1309-1316
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Off Pump ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

Background: Off-pump coronary artery bypass grafting (OPCAB) is an alternative to coronary artery revascularization and avoids the complications of cardiopulmonary bypass (CPB). The procedure’s success, however, depends on intraoperative hemodynamic stability. Preoperative cardiac function can predict the tolerance to compromised hemodynamics during cardiac surgery. Inability to manage hypotension and low cardiac output while manipulating the heart is the most frequent cause of intraoperative conversion to CPB. Objective: The authors investigated the effects of the preoperative left ventricular ejection fraction (LVEF) on the success of OPCAB surgery and the relation of intraoperative factors to the success of OPCAB surgery. Material and Methods: Medical records of 284 patients who underwent OPCAB surgery in Ramathibodi Hospital between January 2015 and December 2017 were retrospectively reviewed. Preoperatively, the patients were classified into groups 1 to 4 based on LVEFs of 50% to 70%, 40% to 49%, 30% to 39%, and <30%, respectively. Preoperative characteristics were collected. Intraoperative success of OPCAB surgery, application of inotropes, vasopressor, fluid, and intra-aortic balloon pump (IABP), and post-operative outcomes were analyzed and compared among the four LVEF groups. Results: No significant differences in success of OPCAB surgery emerged among the four groups (p=0.430). Intraoperative requirements of IABP were significantly higher for LVEF <30% patients (p=0.001). In addition, the time to extubation was significantly delayed (p=0.001) and the LVEF <30% patients stayed longer in intensive care unit (ICU) (p=0.002) when compared with the good LVEF patients. There were no significant differences in the operative time, amount of intravenous fluid, blood transfusion requirement, or blood loss among the groups. There were no significant differences in major postoperative morbidities. Conclusion: OPCAB surgery can be performed successfully in patients with severe cardiac dysfunction (LVEF <30%) without significant differences from LVEF ≥30% patients, although the need for an intraoperative IABP device and inotropic drugs for hemodynamic support were greater and the extubation times and ICU stays were longer. Keywords: Coronary artery bypass graft; Left ventricular ejection fraction; Off-pump CABG; OPCAB; Poor cardiac function

Establishing the Safety of Training in Off-Pump Coronary Artery Bypass Surgery: A Retrospective Comparison of Outcomes between Trainees and a Consultant Surgeon

2020 ◽  
Vol 68 (08) ◽  
pp. 674-678
Author(s):  
Soumik Pal ◽  
Philip Hartley ◽  
Yousuf Salmasi ◽  
George Asimakopoulos
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Statistical Significance ◽  
Artery Bypass ◽  
Off Pump ◽  
Consultant Surgeon ◽  
Mediastinal Infection ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass ◽  
The Uk

Abstract Background The safety of training in off-pump coronary artery bypass (OPCAB) surgery and the stage at which trainees should be exposed to this technique remain controversial. This single-center retrospective study aimed to compare outcomes of OPCAB surgery in consultant and trainee cases. Methods Between 2014 and 2018, all isolated OPCAB operations performed under the care of a consultant surgeon (G.A.) were analyzed. Cases where a surgeon below consultant grade performed at least 70% of the distal anastomoses were designated as “trainee cases” with the remaining cases designated as “consultant cases.” The baseline characteristics of patients, perioperative data, and short-term outcomes were prospectively collated and analyzed. Results During the study period, 245 OPCAB cases were identified: 142 (58%) consultant and 103 (42%) trainee cases. The trainee cases were performed exclusively by trainees in the final 2 years of the UK National Cardiothoracic Training Program. Both trainee and consultant groups had low mortality with two perioperative deaths occurring in either group. The rates of serious postoperative complications including stroke (n = 1 vs. 2, p = 0.759), resternotomy for bleeding (n = 3 vs. 7, p = 0.431), and mediastinal infection (n = 2 vs. 3, p = 0.926) were low and not significantly different between the two groups. Patients operated on by trainees had a slightly longer hospital stay than those operated on by the consultant surgeon, although this did not reach statistical significance (9.9 vs. 7.9 days). Conclusions These results demonstrate comparable outcomes in OPCAB surgery between a consultant surgeon and trainees. This study supports the conclusion that training surgeons in OPCAB is appropriate for trainees in the final years of cardiac surgery training.

scholarly journals Do women benefit more than men from off-pump coronary artery bypass grafting?

2019 ◽  
Vol 27 (12) ◽  
pp. 629-635 ◽  
Author(s):  
J. F. ter Woorst ◽  
A. H. T. Hoff ◽  
M. C. Haanschoten ◽  
S. Houterman ◽  
A. H. M. van Straten ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Opcab Surgery ◽  
The Difference ◽  
Pump Coronary Artery Bypass

Abstract Objectives Outcomes after coronary artery bypass grafting (CABG) are worse in women than in men. This study aims to investigate whether off-pump coronary artery bypass (OPCAB) surgery improves the outcomes in women by comparing different outcome measures in both genders. Methods Patients who underwent isolated CABG, either on-pump (ONCAB) or OPCAB, between January 1998 and June 2017 were included. Primary endpoints were 30-day and 120-day mortality. Logistic regression models were constructed to evaluate the effect of the CABG technique on important outcomes such as mortality and the need for blood transfusion. Results The data of 17,052 patients were analysed, 3,684 of whom were women (414 OPCAB) and 13,368 men (1,483 OPCAB). The mean number of grafts was lower in the OPCAB group of both genders (p < 0.001). Postoperatively, both men and women undergoing OPCAB surgery received fewer red blood cell transfusions (p < 0.001) and had higher postoperative haemoglobin levels (p < 0.001) than those undergoing ONCAB. Early mortality occurred less frequently after OPCAB surgery in both genders, although the difference was not significant. However, 120-day mortality was significantly lower after OPCAB surgery in women, even after correction for preoperative risk factors [odds ratio (OR) = 0.356, 95% confidence interval (CI) 0.144–0.882, p = 0.026]. The difference in 120-day mortality was not significant in men (OR = 0.787, 95% CI 0.498–1.246, p = 0.307). Conclusions Women undergoing CABG benefit more from OPCAB surgery than from ONCAB surgery in terms of 120-day mortality. This difference was not found in men in our patient population.

scholarly journals Early Outcomes Following off-Pump Coronary Artery Bypass Surgery under General Anaesthesia with and without High Thoracic Epidural Analgesia: A Comparative Study

2021 ◽  
Vol 4 (13) ◽  
pp. 01-07
Author(s):  
Chaitali Dasgupta
Keyword(s):  
Coronary Artery ◽  
Epidural Analgesia ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Off Pump ◽  
Thoracic Epidural ◽  
Group I ◽  
Opcab Surgery ◽  
High Thoracic Epidural ◽  
Pump Coronary Artery Bypass

Introduction: Reduction of postoperative morbidity by providing optimal pain relief and improving overall quality of care is an important goal of modern anaesthesia practice. The aim of this prospective, randomized, open, controlled study is to investigate the impact of high thoracic epidural analgesia on early clinical outcomes in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Methodology: After obtaining the institutional ethics committee approval and written informed consent from all patients, 80 patients of either sex, aged 40 – 70 years, scheduled for elective primary OPCAB surgery were randomized into two groups. Group I received 4 mL of an epidural bolus of 1% ropivacaine and fentanyl 100 µg followed by ropivacaine 1% and fentanyl 5 µg/mL infusion for 72 h at 3–5 mL/h postoperatively. Analgesia in the Group II was provided with a continuous IV fentanyl infusion. Patients were given rescue analgesic (inj Tramadol intravenous) when VAS score is >40 in the postoperative period. Results: VAS score, need for rescue analgesics and incidence of postoperative arrythmia were significantly lower in Group I specially for first twenty four hours postoperatively. Time for extubation and length of postoperative ICU stay were found similar in both the groups. Incidence of other outcomes found to be not significant. Conclusion: The pain scores, analgesic requirements and incidence perioperative arryrhmias were significantly less in Group I compared to Group II, but we could not be able to find any significant difference in time for extubation and length of ICU stay, neither in incidence of postoperative MI, CVA, renal failure, blood transfusion and death.

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