By Saul Katz, M.D., Revised 4/02
The goal is to perform CAB with a minimum of insult and preservation of normal physiology.
- Start heating blanket when patient placed on OR table.
- Keep warm until patient draped.
- Bair Hugger to warm head after drapes placed.
- SWAN GANZ CATHETER
- TEE Monitoring
- HEMODYNAMIC function should be stable and optimal prior to the incision.
- ELEVATION & ROTATION of the heart for exposure may require slow manipulation and sometimes IV fluid and inotropic support to maintain blood pressure and cardiac output.
- TRENDELENBURG POSITION may be required during grafting of right coronary or circumflex coronary arteries.
- ROTATION OF THE TABLE to the right may be needed for grafting the circumflex coronary artery.
- FLUID ADMINISTRATION of several liters to restore preload and hemodynamics to allow distortion of the heart may be required.
- PACING of the atrium for rates under 70 is useful. A-V pacing may be required if heart block occurs during occlusion of the RCA.
- INOTROPIC SUPPORT Dopamine (2-6 mcg/kg/min) is the drug of choice to elevate BP after adequate volume has been administered.
- HEPARIN and protamine dosing vary from surgeon to surgeon
- ISCHEMIA occurring after the coronary artery is occluded and then opened can often be relieved by an intra-luminal shunt.
- used during aortic arch reconstruction, etc.
- Cerebral Protection:
- Solumedrol: 10-30 mg/kg
- Children: 20 mg/kg
- Adults: 2 grams
- Pentothal: 3-5 mg /kg just before circulation interrupted
- Ice Bags to head
- Systemic cooling to 27 C.
Dr. Weigel's cases are managed somewhat differently. See Thoracic Epidural Placement on Pain Management Page.