Anesthesia management of patients undergoing off-pump coronary artery bypass grafting: A retrospective study of single center

Abstract

Background: To summarize the current practice of anesthesia management for Chinese patients undergoing off-pump coronary artery bypass (OPCAB) surgery at a large-volume cardiovascular center.

Materials and methods: The clinical data of consecutive patients undergoing isolated, primary OPCAB surgery during the period from September 2019 to December 2019 were retrospectively analyzed. Patient characteristics, intraoperative data, and short-term outcomes were extracted from the Hospital Information System and the Anesthesia Information Management System.

Results: A total of 255 patients who underwent OPCAB surgery were enrolled in the current study. High-dose opioids and short-acting sedatives were the most commonly administrated anesthetics intraoperatively. Pulmonary arterial catheter insertion is frequently performed in patients with serious coronary heart disease. Goal-directed fluid therapy, a restricted transfusion strategy, and perioperative blood management were routinely used. Rational usages of inotropic and vasoactive agents facilitate hemodynamic stability during the coronary anastomosis procedure. Four patients underwent re-exploration for bleeding, but no death was observed.

Conclusions: The study introduced the current practice of anesthesia management at the large-volume cardiovascular center, and the short-term outcomes indicated the efficacy and safety of the practice in OPCAB surgery.

Keywords: anesthesia management; coronary artery bypass; hemodynamics; retrospective; single center.

Figure 1

Hemodynamic monitoring. Radial A was the most conventional arterial blood pressure monitoring site during the operation (242/255, 94.9%). Femoral A puncture (10/255, 5.1%) was applied in the postoperative placement of the intra-aortic balloon pump (IABP) or alternative site while difficult catheterization of Radial A or Brachial A occurred. Internal V (241/255, 94.5%) was the most conventional punctual site in central venous puncture, and PAC (70/255, 27.5%) was utilized in less than one third of OPCAB patients. ABP, arterial blood pressure; CVP, central venous pressure; A, artery; V, vein; PAP, pulmonary arterial pressure; OPCAB, off-pump coronary artery bypass; PAC, pulmonary arterial catheter.

Figure 2

Frequency of anesthesia agents utilization during anesthesia induction period. Sufentanil (254/255, 99.6%), etomidate (233/255, 91.4%), and cisatracurium (217/255, 85.1%) were the most frequent anesthesia agents during induction period.

Figure 3

Frequency of anesthesia agents application during anesthesia maintenance period. Dexmedetomidine (236/255, 92.5%), sufentanil (233/255, 91.4%), cisatracurium (226/255, 88.6%), and propofol (222/255, 87.1%) were the most frequent anesthesia agents during maintenance period.

Figure 4

Inotropic and vasoactive agents (bonus). Methoxamine (195/255, 76.5%) and norepinephrine (98/255, 38.4%) were the most common vasoconstrictors with a fashion of bonus when hypotension occurred.

Figure 5

(A) The frequencies of the inotropic and vasoactive agents usages (continuous infusion) at the end of the surgery. Nitroglycerin (165/255, 64.7%) and dopamine (92/255, 36.1%) were the most frequent vasoactive agents with a fashion of continuous infusion. (B) The individual dosages of inotropic and vasoactive agents were displayed in the scatter plot.

Figure 6

Administration of inotropic and vasoactive agents at the end of the operation. Almost all the patients were sent to ICU with at least one kind of inotropic or vasoactive agent (212/255, 83.1%). ICU, intensive care unit.

Figure 7

Adjuvant drugs. Tranexamic acid (111/255, 43.5%), potassium chloride (97/255, 38.0%), and proton pump inhibitor (76/255, 29.8%) were the most frequent adjuvant drugs.

Figure 8

Heparinization and reversal strategy. Violin plot was applied to display the intraoperative anticoagulation and reversal strategy. The width of the “violin” indicated the distribution and the probability density of the data. The lines inside the “violin” indicated the median and the interquartile range. T1: Interval between the loading injection and the first repeated injection; T2: Interval between the second and third repeated injection; T3 and T4 followed the similar fashion.

Figure 9

Vital signs during the surgery. The hemodynamic fluctuation, oxygenation, and core temperature during the surgery are displayed in this figure. T1 = Before induction (●); T2 = After endotracheal intubation (▪); T3 = Skin incision (▴); T4 = Protamine administration (▾); T5 = During sternum closure (◆); T6 = End of operation (○).