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Table 9. Perioperative Anesthetic and Monitoring
Considerations for CABG
Anesthetic considerations
Perioperative analgesia Nonopioid medications (e.g., acetaminophen, ketamine,
dexmedetomidine) and/or regional techniques (e.g., truncal
nerve blocks), particularly as part of a multimodal analgesic
approach, have been shown to reduce perioperative opioid use in
cardiac surgery.
Maintenance
anesthesia
Although volatile (versus intravenous) anesthesia may facilitate
earlier extubation, recent evidence suggests that the choice of
maintenance anesthetic likely does not impact mortality rate
after cardiac surgery.
Mechanical ventilation An intraoperative lung-protective ventilation strategy (i.e.,
tidal volume of 6–8 mL/kg predicted body weight + positive
end-expiratory pressure) has been shown to improve pulmonary
mechanics and reduce postoperative pulmonary complications.
Goal-directed therapy Goal-directed therapy, which creates protocols for the use of
fluids and vasopressors to target specific hemodynamic goals, has
yielded inconsistent results and requires additional investigation
to determine its use in cardiac surgery.
TEE
CABG + valve
procedures
Intraoperative TEE aids in the real-time assessment of heart
valve function and pathology in those undergoing combination
CABG and valve surgery.
Isolated CABG
procedures
The use of intraoperative TEE in isolated CABG is less
established but has been shown to aid in surgical and
anesthetic decision-making as a tool for real-time assessment of
hemodynamic status, regional wall motion, ventricular function,
valve anatomy, and diastolic function.
Perioperative Considerations in Patients Undergoing CABG
COR LOE
Recommendation
1 B-NR
1. For patients undergoing CABG, establishment of
multidisciplinary, evidence-based perioperative management
programs is recommended to optimize analgesia, minimize
opioid exposure, prevent complications and to reduce time to
extubation, length of stay, and healthcare costs.
General Procedural Issues for CABG
