Holmes Miranda, White Alexander N J, Rogers Luke J, Davierwala Piroze M
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada.
J Cardiovasc Dev Dis. 2025 Jun 18;12(6):232. doi: 10.3390/jcdd12060232.
Minimally invasive coronary artery bypass grafting (MI-CABG) has emerged as a transformative approach to coronary revascularization, offering reduced morbidity, faster recovery and improved cosmesis compared to conventional coronary artery bypass grafting (CABG). Performed without full sternotomy and commonly without cardiopulmonary bypass (CPB), MI-CABG encompasses a variety of techniques. These procedures present unique challenges for the anesthesiologist, necessitating a tailored perioperative strategy. This review explores the anesthetic management of MI-CABG, focusing on preoperative assessment, intraoperative techniques, and postoperative care. Preoperative evaluation emphasizes cardiac, respiratory, and vascular considerations, including suitability for one-lung ventilation (OLV) and the impact of comorbidities. Intraoperatively, anesthesiologists must manage hemodynamic instability, ensure effective OLV, and maintain normothermia. Postoperative strategies prioritize multimodal analgesia, early extubation, and rapid mobilization to leverage the benefits of a minimally invasive approach. By integrating surgical and anesthetic perspectives, this review underscores the anesthesiologist's pivotal role in navigating the physiological demands of MI-CABG. As techniques evolve and experience grows, a comprehensive understanding of these principles will enhance the safety and efficacy of MI-CABG, making it a viable option for an expanding patient population.
微创冠状动脉旁路移植术（MI-CABG）已成为一种变革性的冠状动脉血运重建方法，与传统冠状动脉旁路移植术（CABG）相比，具有发病率降低、恢复更快和美容效果更好的优点。MI-CABG无需完全胸骨切开术，通常也无需体外循环（CPB），包括多种技术。这些手术给麻醉医生带来了独特的挑战，需要制定量身定制的围手术期策略。本综述探讨了MI-CABG的麻醉管理，重点关注术前评估、术中技术和术后护理。术前评估强调心脏、呼吸和血管方面的考虑因素，包括单肺通气（OLV）的适用性和合并症的影响。术中，麻醉医生必须处理血流动力学不稳定，确保有效的OLV，并维持体温正常。术后策略优先考虑多模式镇痛、早期拔管和快速活动，以利用微创方法的优势。通过整合外科和麻醉的观点，本综述强调了麻醉医生在应对MI-CABG生理需求方面的关键作用。随着技术的发展和经验的积累，对这些原则的全面理解将提高MI-CABG的安全性和有效性，使其成为越来越多患者的可行选择。
