Anesthetic management of off-pump simultaneous coronary artery bypass grafting and lobectomy

Abstract

Rationale:Survey data show approximately 10% patients with lung cancer may present concomitant coronary heart disease. Simultaneous surgery is a challenge for anesthetist. We review our experience in the anesthesia with 5 patients who required simultaneous off-pump coronary artery bypass grafting (OPCABG) and pulmonary resection for lung cancer.Patient concerns:Between 2014 and 2016, 5 patients with ASA (American Society of Anesthesiologists) grade II or III, underwent combined OPCABG and lung resection in the first Affiliated Hospital, Zhejiang University School of Medicine.Diagnoses:All five patients were diagnosed with coronary heart disease and peripheral pulmonary carcinomaInterventions:Five patients received general anesthesia with double-lumen endobronchial tube for lung separation. The anesthetics were used, which caused slight hemodynamic fluctuations during induction of anesthesia; while during the maintenance of anesthesia, supplemented by Dexmedetomidine, the drug doses were titrated according to the depth of anesthesia. Guided by cardiac index (CI), stroke volume variation (SVV) and oxygen delivery (DO2), different strategies were taken at the different stage of surgery, during lung resection, SVV was kept about 13% to 15%, and less than 10% during OPCABG.Outcomes:Five patients were transferred to intensive care unit (ICU) with intubation after surgery, duration of ventilation was 10 to 18 hours, and length of ICU stay and hospital stay were 1.8 to 2.5 ds and 11 to 16 ds, respectively. All of patients were discharged with not any perioperative complication.Lessons:In summary, anesthetists should focus on the maintenance of the balance between oxygen supply and demanding, which was achieved by close monitoring, titration of anesthetics and goal-directed fluid therapy during surgical procedures.

Application Effect of Dexmedetomidine and Dezocine in Patients Undergoing Lung Cancer Surgery under General Anesthesia and Analysis of Their Roles in Recovery Time and Cognitive Function

“…Surgery can efficiently resect tumor tissue and dissect metastatic lymph nodes in lung cancer patients, but it is moderately traumatic and can trigger nonspecific reactions in the body, resulting in hemodynamics changes and fluctuating vital signs in patients, and even convincing ischemic damage in severe cases, which in turn elevates the inflammatory level and makes patients experience multiple complications such as organ dysfunction. Cognitive dysfunction is one of the most common postoperative complications of lung cancer [ 17 ], which increases the late mortality of patients. Factors such as stress reaction, surgical trauma, deterioration of cerebrovascular microcirculation, and hypoxemia can raise the possibility of cognitive dysfunction [ 18 ].…”

Anesthetıc Approach In A Case Of Concurrent Off-Pump Coronary Bypass And Lung Resectıon

“…Literatürde böyle hastalarda, tek seferlik veya basamaklı cerrahi yaklaşımın hangisinin seçileceği konusunda kesin bir tercih bulunmamaktadır. [3,4] Her ne kadar perkütan koroner girişimlerin yapıldığı hasta sayısı artsa da stent sonrası akciğer cerrahisi ile arasında en az 6-12 haftalık bekleme süresi gerekliliği, daha hızlı planlanması gereken akciğer kanserli hastaların tedavisini geciktirmektedir. [4,5] Eş zamanlı girişimler operasyon süresini uzatarak mortaliteyi artırırken, basamaklı cerrahi girişim iki kez genel anestezi ve cerrahi girişim gerektirdiğinden hastaların perioperatif stres maruziyetlerini, hastanede kalma sürelerini ve maliyetlerini artırır.…”

“…[3,4] Her ne kadar perkütan koroner girişimlerin yapıldığı hasta sayısı artsa da stent sonrası akciğer cerrahisi ile arasında en az 6-12 haftalık bekleme süresi gerekliliği, daha hızlı planlanması gereken akciğer kanserli hastaların tedavisini geciktirmektedir. [4,5] Eş zamanlı girişimler operasyon süresini uzatarak mortaliteyi artırırken, basamaklı cerrahi girişim iki kez genel anestezi ve cerrahi girişim gerektirdiğinden hastaların perioperatif stres maruziyetlerini, hastanede kalma sürelerini ve maliyetlerini artırır. Diğer problemler, medyan sternotomi ile pulmoner lezyonların yeterince görülememesi, sistemik heparinizasyon ve kardiyopulmoner baypas nedeniyle gelişen koagülopati ve buna bağlı aşırı kanama ve enfeksiyon riskidir.…”

“…Lobektomi için gereken tek akciğer ventilasyonu ve restriktif sıvı tedavisi, koroner arter baypas greftleme sırasında miyokardın oksijen arz talep dengesini karşılayamazken hemodinamik stabilite için risk yaratır. [4] Biz de bu olgu sunumu ile eş zamanlı akciğer kanseri ve koroner kalp hastalığı olan hastalar için kombine cerrahinin güvenliğini ve etkinliğini anesteziyolog gözüyle değerlendirmeyi amaçladık.…”