Autor:

Gille, A.; Ennker, IC.; Ennker, J.; Alexander, T.

Erscheinungsort:

Facts and Myths of Minimally Invasive Cardiac Surgery, Proceedings, New Orleans, Jan 24, 1998

Inhalt:

This report describes our first anesthetic experiences with the MIDCAB technique. The application of more or less invasive monitoring is currently discussed between anesthetists.

We therefore investigated our first 21 consecutive MIDCAB procedures. In addition to our standard monitoring, we used central venous pacing wires and external defibrillator pads. A balanced anaesthesia was maintained by Sufentanil, Propofol and Vecuronium. Ischemic preconditioning was managed by clamping the effected coronary artery for 5 minutes. Intrapleural block for sufficient analgesia was used.

In 4 out of 19 patients, the surgical procedure was altered to the support through the heart-lung-machine. From the remaining patients 8 required operative pacing due to Bradycardia, one patient needed external defibrillation due to cardiac fibrillation. Red packed cells were not necessary due to the application of the cell saver. Temperature at admission on ICU was 35.1 +/- 0.1 OC. The duration for the intubation from arrival at the ICU until extubation was 6.2 +/- 2.2 h.

I.v.-pacing, defibrillation pads were effective, the application of double-lumen tubes with the inherent risks could be avoided. The surgeons obtained an excellent exposure of the heart through displacement of the left lung. Local anesthetics avoided the opioid respiratory depression and improved the pain scores.