Multivessel off-pump coronary artery bypass grafting in a nonagenarian: anesthesiologic management

A 90-year-old male admitted with history of angina (three-vessel disease) on medical therapy for hypertension and chronic renal failure was scheduled for elective coronary artery bypass grafting (CABG). After standard premedication and monitoring anesthesia was induced with propofol and maintained with isoflurane. Middle dose opioids and atracurium were also given. Multivessel. revascularization was done trought median sternotomy and anastomoses were performed with the aid of coronary stabilization and shunting. Cerebral and renal perfusion were maintained with high arterial pressure (140/70 mmHg) and continuous infusion of fenoldopam (0.05 mu g kg(1) m(-1)). The perioperative period was uneventful. Elderly patients are at increased risk for mortality and morbidity after CABG. The procedure can be performed safely on elderly patients without using cardiopulmonary bypass and preventing cerebral and renal ipoperfusion.

A 90-year-old male admitted with history of angina (three-vessel disease) on medical therapy for hypertension and chronic renal failure was scheduled for elective coronary artery bypass grafting (CABG). After standard premedication and monitoring anesthesia was induced with propofol and maintained with isoflurane. Middle dose opioids and atracurium were also given. Multivessel revascularization was done through median sternotomy and anastomoses were performed with the aid of coronary stabilization and shunting. Cerebral and renal perfusion were maintained with high arterial pressure (140/70 mmHg) and continuous infusion of fenoldopam (0.05 microg kg(1) m(-1)). The perioperative period was uneventful. Elderly patients are at increased risk for mortality and morbidity after CABG. The procedure can be performed safely on elderly patients without using cardiopulmonary bypass and preventing cerebral and renal ipoperfusion.

Descriviamo il caso clinico di un paziente di 90 anni, con un’anamnesi positiva per angina e per coronaropatia trivasale in terapia per ipertensione arteriosa ed insufficienza renale, che veniva ricoverato per intervento di bypass aorto coronarico in elezione. Dopo una premedicazione standard, l’induzione era ottenuta con fentanyl 5 µg kg-1, propofol 2 mg kg-1 e per facilitare l’intubazione endotracheale atracurium 0,5 mg kg-1. L’anestesia era mantenuta con propofol 2 mg kg-1 e boli refratti di fentanyl. Dopo il monitoraggio si procedeva quindi ad una sternotomia mediana e ad una rivascolarizzazione completa (4 vasi). Le anastomosi venivano confezionate con impiego di stabilizzatori e con il posizionamento di shunt. Durante l’intervento le perfusioni cerebrale e renale venivano mantenute rispettivamente con pressione arteriosa elevata (140/70 mmHg) e con somministrazione continua di fenoldopam (0,05 µg kg1 m-1). Non si sono verificati eventi patologici nella fase perioperatoria. I pazienti anziani sono esposti ad una maggiore mortalità e morbidità dopo un intervento di bypass aorto coronarico. La procedura può essere eseguita in sicurezza senza l’utilizzo del bypass cardio polmonare e prevenendo l’ipoperfusione cerebrale e renale.