Fast Tracking in Off Pump CABG with Supraglottic Airway and TIVA

Abstract

The standard goals of anesthetic management for an off pump coronary artery bypass (OPCAB) surgery are that it should be safe, provide cardiac and other organ protection and stability, preserve neurocognitive integrity, maintain hemodynamics, allow early emergence and ambulation, and offer pain relief in the postoperative period. The cardiac surgical team should collaborate and plan the best preoperative strategy, so as to provide optimal care and a rapid and expeditious recovery of these patients. Scientific evidence and practical experience make total intravenous anesthesia (TIVA) the recommended choice for cardiac surgery. Use of endotracheal tube (ETT) is associated with certain drawbacks which can be overcome with judicious use of ProSeal laryngeal mask airway (PLMA) for cardiac surgeries too. The core principles of ultrafast track anesthetic (UFTA) technique are choice and titration of short-acting anesthetic drugs, postoperative normothermia, multimodal analgesia, early extubation, ambulation, and discharge. Fast tracking with use of TIVA and PLMA in patients undergoing OPCAB at our center offers certain advantages over other techniques in terms of reduced airway and lung trauma, improved cardiac output and renal perfusion with spontaneous respiration, decreased stress and discomfort of ETT suctioning and weaning from ventilation, substantially reduced requirement of dosages of analgesics, anesthetics and opioids, resulting in better patient hemodynamics, alert and pain-free patient that are more amenable and cooperative for early feeds, postoperative chest physiotherapy and lung recruitment strategies, and early ambulation and discharge.