Anesthesia and perioperative management in coronary artery bypass

Objective: To present the characters of the anesthesia and perioperative management for coronary artery bypass surgery.Methods: 180 patients with severe coronary artery disease receive the coronary bypass surgery from April 1997 to October 1999. Anesthesia induction was performed by minimal doses of midazolam （0.05~0.06 mg/kg）, under threshold dose ketamine （0.5 mg/kg）, fentanyl （10~15 μg/kg） and vecurum 0 15 mg/kg. Isoflurane 0.5%~1.5% in oxygen and continued fentanyl up to 50 μg/kg was administed for maintance. After pump off minimal dosage of propofol was given until returning ICU. The patient′s clinical data, anaesthesia drugs used and hemodynamic situations were analyzed.Results: With this methods we provide smooth induction and stable circulation during all operation procedure. The mean time of aortic close clamp was 55 min, and the cardiopulmonary bypass time was 115 min. Only one case died from allergy of protaming in our group with the mortality 0.6%. Postoperativly, the patient awoke time was 4~6 hours and the mean extubation time was 14 hours.Conclusion: Adopting this protocol in the patient received coronary artery bypass graft even with severe condition provided a smooth induction of anesthesia, maintance, stable hemodynamic responses and effective prevent low blood pressure and arrhythmia which is the main causes of the myocardial ischemia, infraction and death during peri operative time