00566 Anesthesia for direct coronary artery bypass grafting; without pump oxygenator

Name of the Procedure:

Anesthesia for Direct Coronary Artery Bypass Grafting (CABG) without Pump Oxygenator

Summary

Anesthesia for direct coronary artery bypass grafting (CABG) without pump oxygenator is a medical process to ensure a patient remains unconscious and pain-free during a heart surgery where a blocked coronary artery is bypassed using another artery or vein from the patient's body. This type of CABG is performed "off-pump," meaning the heart continues to beat during the surgery without the use of a heart-lung machine.

Purpose

The procedure addresses severe coronary artery disease where one or more coronary arteries are blocked. The goal is to improve blood flow to the heart muscle, alleviate symptoms such as chest pain (angina), and reduce the risk of heart attack.

Indications

• Patients with severe coronary artery disease.
• Symptoms such as chronic chest pain (angina), shortness of breath, or fatigue.
• Failed response to other treatments like medication or angioplasty.
• Presence of blockages in critical areas where a bypass is deemed necessary.

Preparation

• Fasting for at least 8 hours before the surgery.
• Adjusting or stopping certain medications, as advised by the doctor.
• Undergoing pre-operative tests such as blood tests, chest X-ray, ECG, and stress tests.
• Meeting with the anesthesiologist to discuss medical history and anesthesia plan.

Procedure Description

1. Upon arriving in the operating room, the patient is monitored with electrodes for ECG, blood pressure cuffs, and oxygen saturation devices.
2. An intravenous (IV) line is started, and medications for relaxation and sedation are given.
3. General anesthesia is induced via IV and inhaled gases to ensure the patient is fully unconscious.
4. An endotracheal tube is placed for mechanical ventilation.
5. The patient's chest is opened through a median sternotomy.
6. The surgeon identifies and prepares a suitable artery or vein for grafting.
7. The heart continues to beat while the surgeon attaches the graft to bypass the blocked coronary artery.
8. Throughout the procedure, the anesthesiologist monitors vital signs and adjusts anesthesia levels as necessary.
9. Once grafting is completed, anesthesia is gradually reduced, and the patient is taken off mechanical ventilation as they awaken.

Duration

Typically, the anesthesia and surgical procedure take between 3 to 6 hours, depending on the complexity and number of grafts required.

Setting

The procedure is performed in a hospital operating room equipped with specialized cardiac surgery equipment.

Personnel

• Cardiac Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (though not typically used in off-pump procedures)
• Operating Room Technicians

Risks and Complications

• Common risks: Bleeding, infection, adverse reactions to anesthesia.
• Rare risks: Stroke, heart attack, kidney failure, pulmonary complications.
• Management: Close post-operative monitoring, medications, and potential surgical interventions if complications arise.

Benefits

• Improved blood flow to the heart muscle and overall heart function.
• Relief from chest pain and other symptoms.
• Reduced risk of heart attack and improved quality of life.
• Benefits may be recognized immediately post-surgery or gradually over several weeks.

Recovery

• Hospital stay of about 5 to 7 days.
• Initial period in the ICU for close monitoring.
• Gradual increase in physical activity as recommended by the doctor.
• Follow-up appointments to monitor heart function and overall recovery.
• Full recovery typically takes 6 to 12 weeks, with potential restrictions on strenuous activity.

Alternatives

• Medication management for less severe cases.
• Percutaneous coronary interventions (PCI) like angioplasty and stenting.
• Lifestyle changes including diet, exercise, and smoking cessation.
• Each alternative has its pros and cons, with surgery providing more definitive and long-term relief for severe cases.

Patient Experience

During the procedure, the patient will be completely asleep and unconscious due to general anesthesia. Post-procedure, they might experience discomfort, pain at the incision site, and fatigue, which are managed with pain medications and supportive care. Comfort measures are provided to aid in recovery, such as gradual physical therapy and emotional support.