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Hemodynamic management during off-pump coronary artery bypass surgery: a narrative review of proper targets for safe execution and troubleshooting
DC Field | Value | Language |
---|---|---|
dc.contributor.author | 곽영란 | - |
dc.contributor.author | 김광섭 | - |
dc.contributor.author | 심재광 | - |
dc.contributor.author | 유경종 | - |
dc.contributor.author | 윤영남 | - |
dc.date.accessioned | 2023-10-19T05:51:15Z | - |
dc.date.available | 2023-10-19T05:51:15Z | - |
dc.date.issued | 2023-08 | - |
dc.identifier.issn | 2005-6419 | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/196296 | - |
dc.description.abstract | Off-pump coronary surgery requires mechanical cardiac displacement, which results in bi-ventricular systolic and diastolic dysfunction. Although transient, subsequent hemodynamic deterioration can be associated with poor prognosis and, in extreme cases, emergency conversion to on-pump surgery, which is associated with high morbidity and mortality. Thus, appropriate decision-making regarding whether the surgery can be proceeded based on objective hemodynamic targets is essential before coronary arteriotomy. For adequate hemodynamic management, avoiding myocardial oxygen supply-demand imbalance, which includes maintaining mean arterial pressure above 70 mmHg and preventing an increase in oxygen demand beyond the patient's coronary reserve, must be prioritized. Maintaining mixed venous oxygen saturation above 60%, which reflects the lower limit of adequate global oxygen supply-demand balance, is also essential. Above all, severe mechanical cardiac displacement incurring compressive syndromes, which cannot be overcome by adjusting major determinants of cardiac output, should be avoided. An uncompromising form of cardiac constraint can be ruled out as long as the central venous pressure is not equal to or greater than the pulmonary artery diastolic (or occlusion) pressure, as this would reflect tamponade physiology. In addition, transesophageal echocardiography should be conducted to rule out mechanical cardiac displacement-induced ventricular interdependence, dyskinesia, severe mitral regurgitation, and left ventricular outflow tract obstruction with or without systolic motion of the anterior leaflet of the mitral valve, which cannot be tolerated during grafting. Finally, the ascending aorta should be carefully inspected for gas bubbles to prevent hemodynamic collapse caused by a massive gas embolism obstructing the right coronary ostium. | - |
dc.description.statementOfResponsibility | open | - |
dc.language | Korean, English | - |
dc.publisher | 대한마취과학회 | - |
dc.relation.isPartOf | KOREAN JOURNAL OF ANESTHESIOLOGY | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.subject.MESH | Cardiac Output | - |
dc.subject.MESH | Coronary Artery Bypass, Off-Pump* / adverse effects | - |
dc.subject.MESH | Echocardiography, Transesophageal | - |
dc.subject.MESH | Hemodynamics / physiology | - |
dc.subject.MESH | Humans | - |
dc.subject.MESH | Oxygen | - |
dc.title | Hemodynamic management during off-pump coronary artery bypass surgery: a narrative review of proper targets for safe execution and troubleshooting | - |
dc.type | Article | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) | - |
dc.contributor.googleauthor | Jae-Kwang Shim | - |
dc.contributor.googleauthor | Kwang-Sub Kim | - |
dc.contributor.googleauthor | Pierre Couture | - |
dc.contributor.googleauthor | André Denault | - |
dc.contributor.googleauthor | Young-Lan Kwak | - |
dc.contributor.googleauthor | Kyung-Jong Yoo | - |
dc.contributor.googleauthor | Young-Nam Youn | - |
dc.identifier.doi | 10.4097/kja.23103 | - |
dc.contributor.localId | A00172 | - |
dc.contributor.localId | A05895 | - |
dc.contributor.localId | A02205 | - |
dc.contributor.localId | A02453 | - |
dc.contributor.localId | A02576 | - |
dc.relation.journalcode | J01963 | - |
dc.identifier.eissn | 2005-7563 | - |
dc.identifier.pmid | 36824043 | - |
dc.subject.keyword | Cardiac tamponade | - |
dc.subject.keyword | Hemodynamic monitoring | - |
dc.subject.keyword | Mixed venous oxygen saturation | - |
dc.subject.keyword | Off-pump coronary artery bypass | - |
dc.subject.keyword | Swan-ganz catheterization | - |
dc.subject.keyword | Transesophageal echocardiography | - |
dc.contributor.alternativeName | Kwak, Young Lan | - |
dc.contributor.affiliatedAuthor | 곽영란 | - |
dc.contributor.affiliatedAuthor | 김광섭 | - |
dc.contributor.affiliatedAuthor | 심재광 | - |
dc.contributor.affiliatedAuthor | 유경종 | - |
dc.contributor.affiliatedAuthor | 윤영남 | - |
dc.citation.volume | 76 | - |
dc.citation.number | 4 | - |
dc.citation.startPage | 267 | - |
dc.citation.endPage | 279 | - |
dc.identifier.bibliographicCitation | KOREAN JOURNAL OF ANESTHESIOLOGY, Vol.76(4) : 267-279, 2023-08 | - |
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