Coronary artery bypass surgery anesthetic consideration

==ACCF/AHA Guidelines for Anesthetic Considerations during Coronary Artery Bypass surgery ==

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Class I
1. Anesthetic management directed toward early postoperative extubation and accelerated recovery of low to medium-risk patients undergoing uncomplicated CABG is recommended. (Level of Evidence: B)

2. Multidisciplinary efforts are indicated to ensure an optimal level of analgesia and patient comfort throughout the perioperative period. (Level of Evidence: B)

3. Efforts are recommended to improve interdisciplinary communication and patient safety in the perioperative environment (eg, formalized checklist-guided multidisciplinary communication). (Level of Evidence: B).

4. A fellowship-trained cardiac anesthesiologist (or experienced board-certified practitioner) credentialed in the use of perioperative transesophageal echocardiography (TEE) is recommended to provide or supervise anesthetic care of patients who are considered to be at high risk. (Level of Evidence: C).

Class IIa
1. Volatile anesthetic-based regimens can be useful in facilitating early extubation and reducing patient recall. (Level of Evidence: A)

Class IIb
1. The effectiveness of high thoracic epidural anesthesia/analgesia for routine analgesic use is uncertain. (Level of Evidence: B).

Class III: HARM
1. Cyclooxygenase-2 inhibitors are not recommended for pain relief in the postoperative period after CABG. (Level of Evidence: B)

2. Routine use of early extubation strategies in facilities with limited backup for airway emergencies or advanced respiratory support is potentially harmful. (Level of Evidence: C).}}

Guideline Resources

 * 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.