• A P Nierich, J Diephuis, E W Jansen, D van Dijk, J R Lahpor, C Borst, and J T Knape.
• Department of Anesthesiology, The Heart-Lung Institute of Utrecht, University Hospital of Utrecht, The Netherlands.
• J. Cardiothorac. Vasc. Anesth. 1999 Apr 1; 13 (2): 123-9.

ObjectiveTo describe hemodynamic alterations during coronary artery bypass grafting (CABG) without extracorporeal circulation using the Octopus Tissue Stabilizer, and to describe the two anesthetic management protocols based on either general anesthesia with opioids (34 patients) or general anesthesia with high thoracic epidural anesthesia (TEA; 66 patients).DesignA prospective observational report.SettingAn academic university heart center.ParticipantsFirst 100 patients undergoing CABG using the Octopus Tissue Stabilizer.InterventionsNone.Main ResultsCurrent management provided satisfactory results in preventing hypoperfusion of the heart and inadequate systemic circulation without the use of major pharmacologic interventions. Movement of the heart to reach the target site of anastomosis caused hemodynamic alterations. These could easily be corrected by anesthetic interventions, such as fluid load and low doses of inotropes. High TEA allows earlier extubation compared with the opioid anesthesia technique (0.9 v 4.5 hours). Perioperative management and the incidence of postoperative complications did not differ between anesthetic techniques. Major complications, such as death, intraoperative myocardial infarction, and stroke, did not occur.ConclusionBoth anesthetic protocols are safe and effective in handling these patients. Off-pump CABG surgery requires anesthetic interventions because hemodynamic alterations are caused by the presentation of the heart to the surgeon. The complication rate is low but needs to be evaluated, compared with conventional CABG, in a prospective randomized study. High thoracic epidural anesthesia allows early recovery, but improved outcome could not be proved in this patient group.

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