Anesthetic management during cardiopulmonary bypass: a systematic review

Anesthesia and Analgesia
Aaron E BarryMartin J London

Abstract

Cardiopulmonary bypass (CPB) required for cardiac surgery presents unique challenges to the cardiac anesthesiologist responsible for providing the 3 most basic facets of any anesthetic: amnesia, analgesia, and muscle relaxation. Unique pathophysiologic changes during CPB result in pharmacokinetic alterations that impact the serum and tissue concentrations of IV and volatile anesthetics. Similarly, CPB causes pharmacodynamic alterations that impact anesthetic efficacy. The clinical significance of these alterations represents a "moving target" as practice evolves and the technology of CPB circuitry advances. In addition, perfusionists choose, modify, and maintain the CPB circuitry and membrane oxygenator. Thus, their significance may not be fully appreciated by the anesthesiologist. These issues have a profound impact on the anesthetic state of the patient. The delivery and maintenance of anesthesia during CPB present unique challenges. The perfusionist may be directly responsible for the delivery of anesthetic during CPB, a situation unique to the cardiac suite. In addition, monitors of anesthetic depth-assessment of clinical signs, hemodynamic indicators, the bispectral index monitor, end-tidal anesthetic concentration, or twi...Continue Reading

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Citations

Dec 5, 2015·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Mark M SmithNiki M Dietz
Oct 3, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Alexander WahbaUNKNOWN EACTS/EACTA/EBCP Committee Reviewers
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Oct 13, 2020·The Cochrane Database of Systematic Reviews·Ben GibbisonBarnaby C Reeves
Dec 1, 2020·Journal of Thrombosis and Haemostasis : JTH·Justyna Bartoszko, Keyvan Karkouti
Jan 17, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Alberto ZangrilloFabrizio Monaco
Oct 11, 2020·Journal of Cardiothoracic and Vascular Anesthesia·Mohammad Irfan AkhtarGudrun Kunst
Jul 18, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Mark A Chaney
Jul 20, 2021·Current Anesthesiology Reports·Christopher Uhlig, Jakob Labus

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