Coronary artery bypass surgery anesthetic considerations

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Coronary Artery Bypass Surgery Microchapters


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Saphenous Vein Graft Disease
Other Non-Atherosclerotic Saphenous Vein Graft Diseases

Indications for CABG



Imaging in the Patient Undergoing CABG

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Goals of Treatment

Perioperative Management

Perioperative Monitoring

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Pulmonary Artery Catheterization
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Surgical Procedure

Anesthetic Considerations
Intervention in left main coronary artery disease
The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)
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Conduits Used for Bypass
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Post-Operative Care and Complications

Recommendation for Duration of DAPT in Patients With ACS Treated With CABG

Special Scenarios

Anomalous Coronary Arteries
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[1]

Anesthetic Considerations (DO NOT EDIT)[1]

Class I
"1. Anesthetic management directed toward early postoperative extubation and accelerated recovery of low to medium-risk patients undergoing uncomplicated CABG is recommended.[2][3][4] (Level of Evidence: B)"
"2. Multidisciplinary efforts are indicated to ensure an optimal level of analgesia and patient comfort throughout the perioperative period.[5][6][7][8][9] (Level of Evidence: B)"
"3. Efforts are recommended to improve interdisciplinary communication and patient safety in the perioperative environment (eg, formalized checklist-guided multidisciplinary communication).[10][11][12][13] (Level of Evidence: B)"
"4. A fellowship-trained cardiac anesthesiologist (or experienced board-certified practitioner) credentialed in the use of perioperative transesophageal echocardiography (TEE) is recommended to provide or supervise anesthetic care of patients who are considered to be at high risk.[14][15][16] (Level of Evidence: C)"
"1. Cyclooxygenase-2 inhibitors are not recommended for pain relief in the postoperative period after CABG.[17][18] (Level of Evidence: B)"
"2. Routine use of early extubation strategies in facilities with limited backup for airway emergencies or advanced respiratory support is potentially harmful. (Level of Evidence: C)"
Class IIa
"1. Volatile anesthetic-based regimens can be useful in facilitating early extubation and reducing patient recall.[3][19][20][21] (Level of Evidence: A)"
Class IIb
"1. The effectiveness of high thoracic epidural anesthesia/analgesia for routine analgesic use is uncertain.[22][23][24][25] (Level of Evidence: B)"


  • 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[1].


  1. 1.0 1.1 1.2 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  2. Hawkes CA, Dhileepan S, Foxcroft D (2003). "Early extubation for adult cardiac surgical patients". Cochrane Database Syst Rev (4): CD003587. doi:10.1002/14651858.CD003587. PMID 14583985.
  3. 3.0 3.1 Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC (2003). "A systematic review of the safety and effectiveness of fast-track cardiac anesthesia". Anesthesiology. 99 (4): 982–7. PMID 14508335.
  4. van Mastrigt GA, Maessen JG, Heijmans J, Severens JL, Prins MH (2006). "Does fast-track treatment lead to a decrease of intensive care unit and hospital length of stay in coronary artery bypass patients? A meta-regression of randomized clinical trials". Crit Care Med. 34 (6): 1624–34. doi:10.1097/01.CCM.0000217963.87227.7B. PMID 16614584.
  5. Bainbridge D, Martin JE, Cheng DC (2006). "Patient-controlled versus nurse-controlled analgesia after cardiac surgery--a meta-analysis". Can J Anaesth. 53 (5): 492–9. doi:10.1007/BF03022623. PMID 16636035.
  6. Brennan F, Carr DB, Cousins M (2007). "Pain management: a fundamental human right". Anesth Analg. 105 (1): 205–21. doi:10.1213/01.ane.0000268145.52345.55. PMID 17578977.
  7. Serfontein L (2010). "Awareness in cardiac anesthesia". Curr Opin Anaesthesiol. 23 (1): 103–8. doi:10.1097/ACO.0b013e328334cb75. PMID 19949325.
  8. Lahtinen P, Kokki H, Hynynen M (2006). "Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity". Anesthesiology. 105 (4): 794–800. PMID 17006079.
  9. Taillefer MC, Carrier M, Bélisle S, Levesque S, Lanctôt H, Boisvert AM; et al. (2006). "Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: a cross-sectional study". J Thorac Cardiovasc Surg. 131 (6): 1274–80. doi:10.1016/j.jtcvs.2006.02.001. PMID 16733157.
  10. Martinez EA, Marsteller JA, Thompson DA, Gurses AP, Goeschel CA, Lubomski LH; et al. (2010). "The Society of Cardiovascular Anesthesiologists' FOCUS initiative: Locating Errors through Networked Surveillance (LENS) project vision". Anesth Analg. 110 (2): 307–11. doi:10.1213/ANE.0b013e3181c92b9c. PMID 20081130.
  11. Wadhera RK, Parker SH, Burkhart HM, Greason KL, Neal JR, Levenick KM; et al. (2010). "Is the "sterile cockpit" concept applicable to cardiovascular surgery critical intervals or critical events? The impact of protocol-driven communication during cardiopulmonary bypass". J Thorac Cardiovasc Surg. 139 (2): 312–9. doi:10.1016/j.jtcvs.2009.10.048. PMID 20106395.
  12. Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH; et al. (2010). "Association between implementation of a medical team training program and surgical mortality". JAMA. 304 (15): 1693–700. doi:10.1001/jama.2010.1506. PMID 20959579.
  13. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP; et al. (2009). "A surgical safety checklist to reduce morbidity and mortality in a global population". N Engl J Med. 360 (5): 491–9. doi:10.1056/NEJMsa0810119. PMID 19144931.
  14. Cahalan MK, Stewart W, Pearlman A, Goldman M, Sears-Rogan P, Abel M; et al. (2002). "American Society of Echocardiography and Society of Cardiovascular Anesthesiologists task force guidelines for training in perioperative echocardiography". J Am Soc Echocardiogr. 15 (6): 647–52. PMID 12050607.
  15. Mathew JP, Glas K, Troianos CA, Sears-Rogan P, Savage R, Shanewise J; et al. (2006). "American Society of Echocardiography/Society of Cardiovascular Anesthesiologists recommendations and guidelines for continuous quality improvement in perioperative echocardiography". J Am Soc Echocardiogr. 19 (11): 1303–13. doi:10.1016/j.echo.2006.08.039. PMID 17098131.
  16. Thys DM (2009). "Cardiac anesthesia: thirty years later--the second annual Arthur E. Weyman lecture". Anesth Analg. 109 (6): 1782–90. doi:10.1213/ANE.0b013e3181be4002. PMID 19923503.
  17. Nussmeier NA, Whelton AA, Brown MT, Langford RM, Hoeft A, Parlow JL; et al. (2005). "Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery". N Engl J Med. 352 (11): 1081–91. doi:10.1056/NEJMoa050330. PMID 15713945.
  18. Ott E, Nussmeier NA, Duke PC, Feneck RO, Alston RP, Snabes MC; et al. (2003). "Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery". J Thorac Cardiovasc Surg. 125 (6): 1481–92. PMID 12830070.
  19. Dowd NP, Cheng DC, Karski JM, Wong DT, Munro JA, Sandler AN (1998). "Intraoperative awareness in fast-track cardiac anesthesia". Anesthesiology. 89 (5): 1068–73, discussion 9A. PMID 9821994.
  20. Groesdonk HV, Pietzner J, Borger MA, Fassl J, Haentschel D, Paarmann H; et al. (2010). "The incidence of intraoperative awareness in cardiac surgery fast-track treatment". J Cardiothorac Vasc Anesth. 24 (5): 785–9. doi:10.1053/j.jvca.2010.03.018. PMID 20537922.
  21. Cheng DC, Karski J, Peniston C, Raveendran G, Asokumar B, Carroll J; et al. (1996). "Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use. A prospective, randomized, controlled trial". Anesthesiology. 85 (6): 1300–10. PMID 8968177.
  22. Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT; et al. (2010). "Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition)". Reg Anesth Pain Med. 35 (1): 64–101. PMID 20052816.
  23. Murphy GS, Szokol JW, Marymont JH, Vender JS, Avram MJ, Rosengart TK; et al. (2003). "Recovery of neuromuscular function after cardiac surgery: pancuronium versus rocuronium". Anesth Analg. 96 (5): 1301–7, table of contents. PMID 12707123.
  24. Nygård E, Kofoed KF, Freiberg J, Holm S, Aldershvile J, Eliasen K; et al. (2005). "Effects of high thoracic epidural analgesia on myocardial blood flow in patients with ischemic heart disease". Circulation. 111 (17): 2165–70. doi:10.1161/01.CIR.0000163551.33812.1A. PMID 15851604.
  25. Tenenbein PK, Debrouwere R, Maguire D, Duke PC, Muirhead B, Enns J; et al. (2008). "Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery". Can J Anaesth. 55 (6): 344–50. doi:10.1007/BF03021489. PMID 18566197.