36
Treatment
Table 9. Perioperative Anesthetic and Monitoring
Considerations for CABG
Pulmonary artery catheters
High-risk surgery Highly selective use of pulmonary artery catheters for high-risk
patients (i.e., older, with congestive heart failure, pulmonary
hypertension, or previous multiple valve procedures) may be
safe and may potentially aid in the surveillance and treatment of
hemodynamic instability.
Low-risk surgery The use of pulmonary artery catheters in low-risk or clinically
stable patients is discouraged because the practice is associated
with increased interventions that incur greater healthcare
expense without associated improvement in morbidity or
mortality rates.
Central nervous system monitoring
Cerebral oxygen
saturation
Intraoperative monitoring of cerebral oxygen saturation (i.e.,
near-infrared spectroscopy) to detect cerebral hypoperfusion
has been shown to guide anesthetic decision-making and may
prevent postoperative neurocognitive dysfunction.
Processed
electroencephalogram
Routine use of intraoperative monitoring of processed
electroencephalogram (i.e., bispectral index) has yielded
inconsistent results with respect to the prevention of recall,
determination of depth of anesthesia, or improvement in rate of
recovery after cardiac surgery.
(cont'd)
Bypass Conduits in Patients Undergoing CABG
COR LOE
Recommendations
1 B-R 1. In patients undergoing isolated CABG, the use of a radial
artery is recommended in preference to a saphenous vein
conduit to graft the second most important, significantly
stenosed, non-LAD vessel to improve long-term cardiac
outcomes.
1 B-NR 2. In patients undergoing CABG, an IMA, preferably the left,
should be used to bypass the LAD when bypass of the LAD is
indicated to improve survival and reduce recurrent ischemic
events.
2a B-NR 3. In patients undergoing CABG, BIMA grafting by experienced
operators can be beneficial in appropriate patients to improve
long-term cardiac outcomes.
