Hemmerling Thomas M, Romano Gianmarco, Terrasini Nora, Noiseux Nicolas
Department of Anesthesia, McGill University, Montreal, Canada.
Ann Card Anaesth. 2013 Jan-Mar;16(1):28-39. doi: 10.4103/0971-9784.105367.
The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB) surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.
心脏不停跳手术技术和知识的发展促使麻醉领域开发新的程序和创新方法，以提高患者安全性并确保高标准的医疗护理。与体外循环心脏手术相比，非体外循环冠状动脉搭桥（OPCAB）手术已显示出一些优势，特别是在减少术后并发症方面，包括全身炎症、心肌损伤和脑损伤。通过有限的开胸切口对单支血管进行OPCAB的微创手术可进一步减少并发症。麻醉医生必须应对不同问题，包括在主动脉冠状动脉搭桥移植术中的血流动力学不稳定和心肌缺血。麻醉医生和外科医生应协作并制定最佳的围手术期策略，以提供最佳护理并确保快速完全康复。在心脏不停跳手术中使用高位胸段硬膜外镇痛和快通道麻醉具有特殊益处。出色的镇痛效果、降低心肌氧耗的能力以及良好的血流动力学稳定性使高位胸段硬膜外镇痛成为一项有吸引力的技术。心脏麻醉正在出现新的情况：在手术室进行拔管的超快通道麻醉和清醒手术往往侵入性较小，但只能针对特定患者进行。
