TY - CHAP M1 - Book, Section TI - Routine Cardiac Surgery and Anesthesia A1 - Wasnick, John D. A1 - Nicoara, Alina Y1 - 2019 N1 - T2 - Cardiac Anesthesia and Transesophageal Echocardiography, 2e AB - In decades past, the otherwise healthy patient for coronary bypass surgery was the “ideal” patient for cardiac surgery/anesthesia teams*. Such patients often presented with one- or two-vessel coronary artery disease in need of surgical revascularization. Perhaps the patient had suffered a myocardial infarction but, overwhelmingly, ventricular function tended to be preserved. Free from both systolic and diastolic ventricular dysfunction, such patients tolerated anesthesia induction, maintenance, and emergence easily. Often these patients were relatively young, in their forties, fifties, and sixties and lacked other organ system diseases. Time on cardiopulmonary bypass tended to be short because the patients often required only one or two vessel revascularizations.Today, patients presenting for coronary artery surgery are anything but “routine.” Frequently they will have already undergone numerous percutaneous coronary interventions (PCIs) prior to being referred for surgery. Many patients will have had a history of recurrent small myocardial infarctions, anginal episodes, and catheterizations. Over time, myocardial damage accrues, leaving some patients with systolic and diastolic ventricular dysfunction. Other patients are referred for coronary bypass surgery because they have complex coronary artery lesions not readily amenable to PCI (e.g., patients with high SYNTAX scores—see Chapter 1) or they have concurrent valvular heart disease.Although few of today’s patients for coronary revascularization are “easy” to manage, review of the anesthesia management for this particular surgical procedure provides an overview of the anesthesia maneuvers necessary in the management of almost all adult cardiac surgeries. In other words, the skills and techniques applied in managing the “routine” coronary artery bypass graft (CABG) surgery also apply when managing anesthesia for more complex procedures.*Warning: There is no such thing as routine cardiac anesthesia. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1166980231 ER -