CABG Flashcards
Explain CABG
CABG involves the grafting of the (LIMA)internal mammary artery right or left and/or segments of
autologous saphenous vein (SVG),to bypass coronary artery obstruction.
Approach is through median sternotomy.
The SVG portion, taken from the leg, is sewn onto the distal coronary artery past the blockage andthen proximally sewn onto the aorta.
The internal mammary usually maintains its blood supply proximally and the distal end is sewn onto the coronary artery, bypassing the blockage.
POSITION foR CABG
Supine position, with a shoulder roll used to slightly extend the head. Arms are placed on padding and
tucked.
After the arms are tucked
After the arms are tucked at the sides, check the function of both arterial line and IV lines.
Changing the patient position during CABG?
Why do they change from Trendelenburg to reverse trendelenburg?
Changing the patient from Trendelenburg to reverse Trendelenburg position can help to increase or decrease preload and maintain blood pressure within specific parameters.
Trendelenburg to reverse Trendelenburg position changes are often requested by the surgeon to facilitate air evacuation.
Anesthetic considerations lines
. Notify the surgeon if the BP difference between the arms
is greater than 15-20 mmHg.
Arterial & central lines and monitors are usually placed while the patient is sedated, but before
general anesthesia is initiated.
CABG Anesthetic Considerations: Oxygen is
given by nasal cannula looped up to the top of the head so that it will not be in the way during internal jugular CVP and PAC placement.
CABG any IV placed? why?
Any IV’s placed preoperatively may be of a small gauge. Do not remove them, but rather cap them
and start larger lines. Bleeding can occur or a hematoma may form after heparinization. Any attempted IV should be managed with a pressure dressing.
Preference Aline placement for Left IMA and why ?
The preference for an arterial line is for right radial placement if a left internal mammary artery (LIMA) is to be dissected because the sternal retractor can compress the left subclavian artery. If the
LIMA won’t be used, the arterial line should be placed in the radial artery of the arm that has a BP that
is more than 15mmHg higher than the other
CABG EBL
Third space
Duration
Third Space, Expected Blood Loss):
Third space losses: 1ml/kg,
EBL = 500-600ml. Duration: 3.5-4.5 hrd Pain: 7-8
CABG induction meds
Induction: fentanyl 10-100 mcg/kg or sufentanil 2.5-20 mcg/kg with etomidate 0.1-0.3 mg/kg or midazolam
50- 350 mcg/kg.
CABG muscle relaxation
Muscle relaxation with vecuronium 80-100 mcg/kg.
CABG Important to avoid
Use what MEDS to avoid it? ESL
the sympathetic response to laryngoscopy, use
esmolol 100-500 mcg/kg over 1 min,
sodium nitroprusside 0.5-3 mcg/kg,
lidocaine 1-2 mg/kg or a combo to decrease or prevent this response.
CABG if evidence of ischemia (think ST depression or elevation or t wave inversion)
NTG 0.5-2 mcg/kg/min if evidence of
ischemia occurs.
Maintenance:
Usually fentanyl 10-100 mcg/kg or sufentanil 5-20 mcg/kg with midazolam 50-350 mcg/kg for amnesia. I
Maintenance GAS
Iso, sevo, or des to 0.5 MAC. N2O is generally avoided.
