Anesthetic management during off-pump multi-vessel CABG requires careful hemodynamic control using alpha-stimulants and heart rate reduction to counteract the significant decreases in blood pressure and cardiac index caused by stabilizer placement.
Stabilizer placement may cause hemodynamic decline in off-pump CABG; supports targeted alpha-stimulant use with rate control but leaves open prospective validation.
胸骨全切開下に体外循環を用いず常温,心拍動下に回旋枝を含む多枝冠動脈バイパス術を行うOff pumpCABGを10症例経験した.末梢側吻合時に血圧,心係数はスタビライザ装着により装着前に比して有意に低下した.心拍数の上昇,心収縮力の増加は血管吻合を困難にするためβ刺激作用のあるカテコラミンの投与は少量にとどめ,純粋なα刺激薬により末梢血管抵抗を上昇させて血圧を維持した.心拍数はプロポフォール,ジルチアゼムを用い80beats・min-1程度に維持した.適正な麻酔深度を保ちつつ早期抜管を目指し,循環動態の安定と良好な術野の提供を両立させる麻酔管理が要求された.
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Iwasaki et al. (2001) studied this question.
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