How is anesthesia initially administered in coronary artery bypass grafting (CABG)?

Updated: Dec 04, 2019
  • Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

After standard monitoring equipment is attached and peripheral venous access is achieved but before the arterial line is inserted, the midazolam dose is administered. Before placement of the arterial line, ensure that a radial artery graft will not be used for CABG.

During induction and tracheal intubation, it is important to maintain a steady heart rate and blood pressure. Thus, patients should be preoxygenated. Induction of anesthesia is accomplished with high doses of an opioid (usually fentanyl or remifentanil) to minimize the dose of propofol, etomidate, or thiopental, and thereby maximize cardiovascular stability. Although etomidate usually does not cause changes in blood pressure, it may induce hypotension in cardiac patients.


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