P Pu ur rp po os se e: : To examine the feasibility of immediate extubation after off-pump coronary artery bypass grafting (OPCAB) using opioid based analgesia or high thoracic epidural analgesia (TEA) and compare postoperative analgesia with continuous TEA vs patient-controlled analgesia (PCA).M Me et th ho od ds s: : One hundred consecutive patients undergoing OPCAB were included in this prospective audit. After induction of anesthesia using fentanyl 2 to 5 µg·kg -1 , propofol 1 to 2 mg·kg -1 and endotracheal intubation facilitated by rocuronium, anesthesia was maintained using sevoflurane titrated according to bispectral index monitoring. Perioperative analgesia was provided by TEA (n = 63) at the T3/T4 interspace or T4/T5 interspace using bupivacaine 0.125% 8 to 14 mL·hr -1 and repetitive boluses of bupivacaine 0.25% during surgery. In patients who were fully anticoagulated or refused TEA, perioperative analgesia was achieved by iv fentanyl boluses (up to 15 µg·kg -1 ) and remifentanil 0.1 to 0.2 µg·kg -1 ·min -1 , followed by morphine PCA after surgery (n = 37). Maintenance of body temperature was achieved by a heated operating room and forced-air warming blankets.R Re es su ul lt ts s: : Ninety-five patients were extubated within 25 min after surgery (PCA, n = 33; TEA, n = 62). Five patients were not extubated immediately because their core temperature was lower than 35°C. One patient was re-intubated because of agitation (TEA group); one was re-intubated because of severe pain and morphine-induced respiratory depression (PCA group). Pain scores were low after surgery, with pain scores in the TEA group being significantly lower immediately, at six hours, 24 hr and 48 hr after surgery (P < 0.05).C Co on nc cl lu us si io on n: : Immediate extubation is possible after OPCAB using either opioid-based analgesia or TEA. TEA provides significantly lower pain scores after surgery in comparison to morphine PCA. Objectif : Vérifier la faisabilité de l'extubation immédiatement après un pontage aortocoronarien à coeur battant (PACCB) en utilisant une analgésie avec opioïdes ou une analgésie péridurale thoracique (APT), et comparer l'analgésie postopératoire avec APT continue ou analgésie auto-contrôlée (AAC). Méthode : Cent patients consécutifs devant subir un PACCB ont été inclus dans un audit prospectif. Après l'induction de l'anesthésie avec

This study indicates that during off-pump cardiac bypass surgery, sevoflurane and isoflurane provide the same ischaemic cardioprotective effects. There is no difference for heart contractility and haemodynamic values during and after off-pump cardiac bypass surgery between the two agents. Sevoflurane allows a more rapid recovery from anaesthesia, but this does not translate into better pulmonary function or haemodynamics. Both agents are similar in ultra-fast-track off-pump cardiac bypass surgery.

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Bradycardia and hypotension are common during off-pump coronary artery bypass grafting (OPCAB). We present a case of possible reversible global cerebral hypoperfusion during distal grafting of the left circumflex coronary artery. The bispectral index (BIS) suddenly decreased from values of 45-50 to 0 during distal grafting. Neurologic evaluation after immediate tracheal extubation in the operating room was normal and the 58 yr old patient did not suffer any neurologic sequelae. Postoperative recovery was uneventful and the patient was discharged 5 days after surgery. Cerebral hypoperfusion is a possible complication during OPCAB. BIS monitoring in OPCAB could be an indicator of cerebral hypoperfusion.

Ultra-fast track anesthesia using sevoflurane seems more advantageous than desflurane for anesthesia, for OPCABG, as it is associated with significantly less atrial fibrillation or supraventricular arrhythmias after surgery.