Skip to Main Content


  1. Initiation of cardiopulmonary bypass triggers an extremely complex and multifactorial response involving activation of complement, platelets, neutrophils, monocytes, and macrophages, thus initiating the coagulation, fibrinolytic, and kallikrein cascades. The systemic inflammatory response to cardiopulmonary bypass is further amplified by subsequent stimulated release of various endotoxins and cytokines, including interleukins and tumor necrosis factor, which further promote endothelial cell permeability.

  2. Preparation for separation from cardiopulmonary bypass must be based on a clear understanding of the patient's preoperative condition and events of the operative course. Weaning from cardiopulmonary bypass is initiated after review and adjustment of numerous physiologic and technical variables, including temperature, laboratory data, heart rate and rhythm, myocardial contractility, and mechanical ventilation.

  3. The anesthetic management of patients undergoing coronary artery bypass graft surgery requires an understanding of myocardial oxygen supply and demand, patient monitoring, and the anesthetic techniques that provide myocardial protection and favor oxygen supply over demand.

  4. Patients with coronary artery disease presenting for coronary artery bypass graft surgery require special considerations in their anesthetic management. First and foremost are techniques that minimize myocardial oxygen demand while maximizing myocardial oxygen delivery. These considerations include preoperative preparation, intraoperative monitoring, and the use of anesthetic agents with hemodynamic effects that favor oxygen supply over demand and allow for myocardial protection. Postoperative management that provides particular attention to pain management, temperature control, and hemodynamic monitoring to avoid tachycardia, hypotension, and hypertension also must be considered.

  5. Modern practices that focus on early extubation and "fast-tracking" cardiac surgical patients through the postoperative period use smaller narcotic doses, with supplementation by short-acting hypnotic agents.

  6. Patients at risk for increased mortality after coronary artery bypass graft surgery are identified by preoperative factors. The most significant risk factors that increase mortality are older than 80 years of age, emergent surgery, prior cardiac surgery, and renal failure.

  7. The unifying concept in all valve surgery includes the principles of preserving myocardial function and the influence of preload, afterload, inotropy, rate, rhythm, and diastolic function on myocardial performance and mechanics.

  8. Intraoperative transesophageal echocardiography is an essential diagnostic tool and monitor of cardiac performance for patients undergoing heart valve procedures.

  9. Cardiac anesthesia for heart valve surgery is associated with a number of special considerations not found in other aspects of cardiothoracic anesthesiology. Among these considerations is familiarity with the type of repair technique or prosthetic valve used.

  10. The process of repairing or replacing a portion of the thoracic aorta typically requires the temporary or permanent interruption of blood flow through the aorta or its major branch vessels, creating the potential for ischemia or infarction of almost any major organ system. Techniques to protect organs during temporary interruption of blood flow in the thoracic aorta include deep hypothermic circulatory arrest, selective antegrade cerebral perfusion, retrograde cerebral perfusion, and partial left heart bypass for distal aortic perfusion. Intraoperative neurophysiologic monitoring and lumbar cerebrospinal fluid drainage are recognized techniques commonly used for repairs involving the descending thoracic or thoracoabdominal aorta to decrease the risk of spinal cord ischemia and infarction.

  11. Preoperatively, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.