Perioperative Anesthesia Management for Cardiac Surgery

Patients were premedicated with 1–2 mg lorazepam orally 1 h before surgery and received 0.1 mg kg⁻¹ morphine intramuscularly before entering the operating room where midazolam was given (0.01–0.05 mg kg⁻¹ intravenously) as needed for patient comfort. Usual monitoring was installed, including a 5-lead electrocardiogram, pulse oximeter, peripheral venous line, radial arterial line, 3-lm catheter, and fast-response thermodilution pulmonary artery catheter. Anesthesia was induced with 1 μg kg⁻¹ sufentanil and 0.04 mg kg⁻¹ midazolam, and muscle relaxation achieved with 0.1 mg kg⁻¹ pancuronium. After tracheal intubation, anesthesia was maintained with 1 μg kg⁻¹ h⁻¹ sufentanil and 0.04 mg kg⁻¹ h⁻¹ midazolam. Intravenous fluids (0.9% normal saline) were administered (7 cc kg⁻¹ h⁻¹) during surgery and titrated according to blood pressure and central venous pressure. A transesophageal echocardiography (TEE) omniplane probe was inserted. Institution of CPB was performed using ascending aortic cannulation and bi-caval or double stage cannulation of the right atrium. Intermittent (4:1) blood cardioplegia was administered during CPB; induction and temperatures ranged from 15 to 29 °C. For coronary revascularizations, systemic temperature was allowed to drift to 34 °C, valvular surgeries and complex procedures to 32–34 °C. Weaning from CPB was undertaken after rewarming to a systemic temperature > 36 °C.