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Part 4. Managing Anesthesia Care
Section E. Specialty Areas of Anesthetic Practice
Chapter 51. Cardiac Anesthesia
Mark A. Chaney, MD, Albert T. Cheung, MD, Christopher A. Troianos, MD, Jessica L. Willert, MD, David A. Zvara, MD, and Stanton K. Shernan, MD
1. Initiation of cardiopulmonary bypass initiates an extremely complex and multifactorial response involving activation of complement, platelets, neutrophils, monocytes, and macrophages, thus initiating the coagulation, fibrinolytic, and kallikrein cascades. The systemic inflammatory response to cardiopulmonary bypass is further amplified by subsequent stimulated release of various endotoxins and cytokines, including interleukins and tumor necrosis factor, which further promote endothelial cell permeability.
2. Preparation for separation from cardiopulmonary bypass must be based on a clear understanding of the patient's preoperative condition and events of the operative course. Weaning from cardiopulmonary bypass is initiated after review and adjustment of numerous physiologic and technical variables, including temperature, laboratory data, heart rate and rhythm, myocardial contractility, and mechanical ventilation.
3. The anesthetic management of patients undergoing coronary artery bypass graft surgery requires an understanding of myocardial oxygen supply and demand, patient monitoring, and the anesthetic techniques that provide myocardial protection and favor oxygen supply over demand.
4. Patients with coronary artery disease presenting for coronary artery bypass graft surgery require special considerations in their anesthetic management. First and foremost are techniques..."
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