Embracing the heart: Perioperative management of patients undergoing off-pump coronary artery bypass grafting using the octopus tissue stabilizer

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 13; no. 2; pp. 123 - 129
• Main Authors: Nierich, Arno P., Diephuis, Jan, Jansen, Erik W.L., van Dijk, Diederik, Lahpor, Jaap R., Borst, Cornelius, T.A. Knape, Johannes
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.04.1999; Elsevier
• Subjects: Adjuvants, Anesthesia - administration & dosage; Anastomosis, Surgical; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, Epidural - methods; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; anesthetic management; Biological and medical sciences; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - instrumentation; Coronary Artery Bypass - methods; Coronary Circulation - physiology; Equipment Design; Female; Fluid Therapy; Hemodynamics - physiology; Humans; Incidence; Intubation, Intratracheal; Male; Medical sciences; MIDCAB; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - instrumentation; Minimally Invasive Surgical Procedures - methods; Myocardial Contraction - drug effects; Myocardial Contraction - physiology; Narcotics - administration & dosage; Octopus; off-pump CABG; Prospective Studies; Safety; Suction - instrumentation; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; thoracic epidural; Treatment Outcome; thoracic epidural; anesthetic management; MIDCAB; Octopus; off-pump CABG; Human; Prognosis; Aspiration; Surgical anastomosis; General anesthesia; Instrumentation; Opiates; Extradural; Regional anesthesia; Aortocoronary; Bypass; Surgery; Technique; Comparative study
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1016/S1053-0770(99)90073-3

Objective: To describe hemodynamic alterations during coronary artery bypass grafting (CABG) without extracorporeal circulation using the Octopus Tissue Stabilizer, and to describe the two anesthetic management protocols based on either general anesthesia with opioids (34 patients) or general anesthesia with high thoracic epidural anesthesia (TEA; 66 patients). Design: A prospective observational report. Setting: An academic university heart center. Participants: First 100 patients undergoing CABG using the Octopus Tissue Stabilizer. Interventions: None. Main Results: Current management provided satisfactory results in preventing hypoperfusion of the heart and inadequate systemic circulation without the use of major pharmacologic interventions. Movement of the heart to reach the target site of anastomosis caused hemodynamic alterations. These could easily be corrected by anesthetic interventions, such as fluid load and low doses of inotropes. High TEA allows earlier extubation compared with the opioid anesthesia technique (0.9 v 4.5 hours). Perioperative management and the incidence of postoperative complications did not differ between anesthetic techniques. Major complications, such as death, intraoperative myocardial infarction, and stroke, did not occur. Conclusion: Both anesthetic protocols are safe and effective in handling these patients. Off-pump CABG surgery requires anesthetic interventions because hemodynamic alterations are caused by the presentation of the heart to the surgeon. The complication rate is low but needs to be evaluated, compared with conventional CABG, in a prospective randomized study. High thoracic epidural anesthesia allows early recovery, but improved outcome could not be proved in this patient group.