1 / 13

Coronary Artery Bypass Grafting in Awake Settings

Coronary Artery Bypass Grafting in Awake Settings. Mitrev Z , Anguseva T. Special hospital for Cardiosurgery “Filip II” Skopje - Macedonia. Myocardial revascularisation in awake patients:. 1.Avoidance of extracoropreal circulation,

sonya-welch
Download Presentation

Coronary Artery Bypass Grafting in Awake Settings

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Coronary Artery Bypass Grafting in Awake Settings Mitrev Z, AngusevaT Special hospital for Cardiosurgery “Filip II” Skopje - Macedonia

  2. Myocardial revascularisation in awake patients: 1.Avoidance of extracoropreal circulation, 2.General anesthesia, endotracheal intubation and mechanical ventilation unnecessary 3.Complete off-Pump revascularisation possible

  3. Material and Metods High epydural analgo-anesthesia N= 10 pts ( 2 femail, 8 mail) - Epidural catheter in place: Th1-Th2 - Main targed: somatosensory and motor block - Applied medicaments: 20ml 0.25%Bupivacain 100gr.Fentanyl, 5ml/min - Sternotomy: patient being without intubation - CABG

  4. Schematic view The catheter is placed in the high epidural space Th1-Th2 one day preoperatively, using the loss of resistance method, or method of getting a drop

  5. Patient demographics (N : 10) • Age (years) 62.2 ± 7.8 • Sex (f/m) 2/8 • BSA (cm2) 1.76 ± 0.2 • Unstable angina n : 5pts • Previous myocardial infarction n : 4pts • Coronarography finding Comorbidities: • LAD 100% (n : 10) Hyperlipidemia – 7pts • LAD 100%; Cx 90% (small) Diabetes disease- 4pts • (n:2) Hypertension – 8pts • COPD – 2pts • Adiposity – 1pts • Smokers – 6pts

  6. Management procedures • First step: epidyral catheter the day before surgery • Second step: The operative day-.Analgosedation with: mixture 1 :0.5% Bupivacain and 1.66g/ml Su-Fentanyl – starting at sternotomy till sternal rewiring mixture 2 : 0.125%Bupivacain and 1 g/ml Su-Fentanyl Day 1 to 3 after surgery • Dosage of the analgosedativa is correlated with: Pts haemodynamic stability Blood-gas analyses Visual analgoscala. Target: pain index 1to3 Third step: Postoperative analgosedatia with mixture 2 (first day)

  7. AWAKE SURGERY

  8. Postoperative management • Third step: Postoperative analgosedatia with mixture 2 (first day) • Epidural cathether pull out after 24 hours • No need of cathecholamine support • No need of other additional sedation except epidural mixture 2 (0.125%Bupivacain and 1 g/ml Su-Fentanyl)

  9. Results I –intraoperative data • Complete sternotomy 10 pts • CABG x1 (LITA - LAD) – 10pts • Mean time of bypassing 7.9±0.8min • Mean time of op.duration 71.7 ± 22.1min • Without intubation 9pts • 1patient intubated after sternotomy: pain index >7 • Entered left pleural spaces 2 pts • Hemodynamical stability in 10 pts

  10. Results II-ICU events • Two patients left the operating room by walk. • Drains were pull out first post op. day in all pts • Hemodynamical stability 9pts • In hospital stay 2,5days 9pts • Without any significant postop. Complications • Follow up – 2 – 42months

  11. Complications: • Perforation of the internal dura (1) • Intensive headache after punction of the dura interna (1) • Collaps due to the Puncture (2) • Radicular pain and back pain (7) • Epidural catheter misplacement (2) The risk of od epidural-spinal hematoma - decreased, following the recommendations of DGAI: --atraumatic inplacement -- appropriate interval of the last anticoagulant therapy

  12. AWAKE SURGERY • Respiratory and haemodynamic stability • Decreased stress • Good ( pre-and postoperative ) Analgesie • Early mobilisation possible • Quick and effective recovery • Better economic side with a exellent clinical outcome

More Related