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Canadian Journal of Anesthesia, Vol 31, 213-220, Copyright © 1984 by Canadian Anesthesiologists' Society

Patient Care Problems in Patients Undergoing Reoperation for Coronary Artery Grafting Surgery

CHESTER BRUMMETT MD1, J. G. REVES MD1, WILLIAM A. LELL MD1, and LLOYD R. SMITH MA1

1 Department of Anesthesiology, The University of Alabama Medical Center, Birmingham, Alabama

Address correspondence to: J.G. Reves MD, Department of Anesthesiology, The University of Alabama Medical Center, 619 19th St. S, Birmingham, Alabama 35294.

Over the past six years there has been a 15-fold increase in the number of patients requiring reoperation coronary artery bypass grafting(RCABG) surgery at the University of Alabama in Birmingham. To determine the perioperative risk, a retrospective chart survey of one calendar year's(1981) experience was made comparing the 58 RCABG patients with 59 cohorts undergoing primary operation. All patients were anaesthetized with diazepam, fentanyl and halothane or enflurane anaesthesia. Preoperative evaluation revealed by history that the incidence of unstable angina and digoxin use were greater (p = 0.05) in the RCABG patients. Cardiac catheterization revealed a higher incidence (26 vs 89 percent) of left main coronary disease in controls and similar indices of left ventricular function (wall abnormalities, ejection fraction and LVEDP). Operating and bypass times were longer (p < 0.01) for RCABG patients and there was a trend for greater (p = 0.08) use of dopamine in the RCABG patients. CK-MB release was significantly (p < 0.05) greater in RCABG patients. Serious postoperative complications (CK-MB ≥ 151U/L, low cardiac output, and death) were significantly (p = 0.02) greater in the RCABG group. It is concluded that RCABG patients represent a greater risk of complications and that new strategies for improving myocardial protection need to be developed to reduce the risk.

Key Words: SURGERY, CARDIAC: coronary artery bypass grafting, reoperation • ANAESTHESIA, CARDIOVASCULAR: myocardial protection






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Copyright © 1984 by the Canadian Anesthesiologists' Society.