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| __NOTOC__
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| {{Coronary artery bypass surgery}}
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| {{CMG}}; {{AOEIC}} {{VK}}
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| ==ACCF/AHA Guidelines for Anesthetic Considerations during Coronary Artery Bypass surgery<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=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. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>==
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| {{cquote|
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
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| '''1.''' Anesthetic management directed toward early postoperative extubation and accelerated recovery of low to medium-risk patients undergoing uncomplicated CABG is recommended.<ref name="pmid14583985">{{cite journal| author=Hawkes CA, Dhileepan S, Foxcroft D| title=Early extubation for adult cardiac surgical patients. | journal=Cochrane Database Syst Rev | year= 2003 | volume= | issue= 4 | pages= CD003587 | pmid=14583985 | doi=10.1002/14651858.CD003587 | pmc= | url= }} </ref><ref name="pmid14508335">{{cite journal| author=Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC| title=A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. | journal=Anesthesiology | year= 2003 | volume= 99 | issue= 4 | pages= 982-7 | pmid=14508335 | doi= | pmc= | url= }} </ref><ref name="pmid16614584">{{cite journal| author=van Mastrigt GA, Maessen JG, Heijmans J, Severens JL, Prins MH| title=Does fast-track treatment lead to a decrease of intensive care unit and hospital length of stay in coronary artery bypass patients? A meta-regression of randomized clinical trials. | journal=Crit Care Med | year= 2006 | volume= 34 | issue= 6 | pages= 1624-34 | pmid=16614584 | doi=10.1097/01.CCM.0000217963.87227.7B | pmc= | url= }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
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| '''2.''' Multidisciplinary efforts are indicated to ensure an optimal level of [[analgesia]] and patient comfort throughout the perioperative period.<ref name="pmid16636035">{{cite journal| author=Bainbridge D, Martin JE, Cheng DC| title=Patient-controlled versus nurse-controlled analgesia after cardiac surgery--a meta-analysis. | journal=Can J Anaesth | year= 2006 | volume= 53 | issue= 5 | pages= 492-9 | pmid=16636035 | doi=10.1007/BF03022623 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16636035 }} </ref><ref name="pmid17578977">{{cite journal| author=Brennan F, Carr DB, Cousins M| title=Pain management: a fundamental human right. | journal=Anesth Analg | year= 2007 | volume= 105 | issue= 1 | pages= 205-21 | pmid=17578977 | doi=10.1213/01.ane.0000268145.52345.55 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17578977 }} </ref><ref name="pmid19949325">{{cite journal| author=Serfontein L| title=Awareness in cardiac anesthesia. | journal=Curr Opin Anaesthesiol | year= 2010 | volume= 23 | issue= 1 | pages= 103-8 | pmid=19949325 | doi=10.1097/ACO.0b013e328334cb75 | pmc= | url= }} </ref><ref name="pmid17006079">{{cite journal| author=Lahtinen P, Kokki H, Hynynen M| title=Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. | journal=Anesthesiology | year= 2006 | volume= 105 | issue= 4 | pages= 794-800 | pmid=17006079 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17006079 }} </ref><ref name="pmid16733157">{{cite journal| author=Taillefer MC, Carrier M, Bélisle S, Levesque S, Lanctôt H, Boisvert AM et al.| title=Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: a cross-sectional study. | journal=J Thorac Cardiovasc Surg | year= 2006 | volume= 131 | issue= 6 | pages= 1274-80 | pmid=16733157 | doi=10.1016/j.jtcvs.2006.02.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16733157 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
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| '''3.''' Efforts are recommended to improve interdisciplinary communication and patient safety in the perioperative environment (eg, formalized checklist-guided multidisciplinary communication). <ref name="pmid20081130">{{cite journal| author=Martinez EA, Marsteller JA, Thompson DA, Gurses AP, Goeschel CA, Lubomski LH et al.| title=The Society of Cardiovascular Anesthesiologists' FOCUS initiative: Locating Errors through Networked Surveillance (LENS) project vision. | journal=Anesth Analg | year= 2010 | volume= 110 | issue= 2 | pages= 307-11 | pmid=20081130 | doi=10.1213/ANE.0b013e3181c92b9c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20081130 }} </ref><ref name="pmid20106395">{{cite journal| author=Wadhera RK, Parker SH, Burkhart HM, Greason KL, Neal JR, Levenick KM et al.| title=Is the "sterile cockpit" concept applicable to cardiovascular surgery critical intervals or critical events? The impact of protocol-driven communication during cardiopulmonary bypass. | journal=J Thorac Cardiovasc Surg | year= 2010 | volume= 139 | issue= 2 | pages= 312-9 | pmid=20106395 | doi=10.1016/j.jtcvs.2009.10.048 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20106395 }} </ref><ref name="pmid20959579">{{cite journal| author=Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH et al.| title=Association between implementation of a medical team training program and surgical mortality. | journal=JAMA | year= 2010 | volume= 304 | issue= 15 | pages= 1693-700 | pmid=20959579 | doi=10.1001/jama.2010.1506 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20959579 }} </ref><ref name="pmid19144931">{{cite journal| author=Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP et al.| title=A surgical safety checklist to reduce morbidity and mortality in a global population. | journal=N Engl J Med | year= 2009 | volume= 360 | issue= 5 | pages= 491-9 | pmid=19144931 | doi=10.1056/NEJMsa0810119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19144931 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''.
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| '''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.<ref name="pmid12050607">{{cite journal| author=Cahalan MK, Stewart W, Pearlman A, Goldman M, Sears-Rogan P, Abel M et al.| title=American Society of Echocardiography and Society of Cardiovascular Anesthesiologists task force guidelines for training in perioperative echocardiography. | journal=J Am Soc Echocardiogr | year= 2002 | volume= 15 | issue= 6 | pages= 647-52 | pmid=12050607 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12050607 }} </ref><ref name="pmid17098131">{{cite journal| author=Mathew JP, Glas K, Troianos CA, Sears-Rogan P, Savage R, Shanewise J et al.| title=American Society of Echocardiography/Society of Cardiovascular Anesthesiologists recommendations and guidelines for continuous quality improvement in perioperative echocardiography. | journal=J Am Soc Echocardiogr | year= 2006 | volume= 19 | issue= 11 | pages= 1303-13 | pmid=17098131 | doi=10.1016/j.echo.2006.08.039 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17098131 }} </ref><ref name="pmid19923503">{{cite journal| author=Thys DM| title=Cardiac anesthesia: thirty years later--the second annual Arthur E. Weyman lecture. | journal=Anesth Analg | year= 2009 | volume= 109 | issue= 6 | pages= 1782-90 | pmid=19923503 | doi=10.1213/ANE.0b013e3181be4002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19923503 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
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| '''1.''' Volatile anesthetic-based regimens can be useful in facilitating early extubation and reducing patient recall.<ref name="pmid14508335">{{cite journal| author=Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC| title=A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. | journal=Anesthesiology | year= 2003 | volume= 99 | issue= 4 | pages= 982-7 | pmid=14508335 | doi= | pmc= | url= }} </ref><ref name="pmid9821994">{{cite journal| author=Dowd NP, Cheng DC, Karski JM, Wong DT, Munro JA, Sandler AN| title=Intraoperative awareness in fast-track cardiac anesthesia. | journal=Anesthesiology | year= 1998 | volume= 89 | issue= 5 | pages= 1068-73; discussion 9A | pmid=9821994 | doi= | pmc= | url= }} </ref><ref name="pmid20537922">{{cite journal| author=Groesdonk HV, Pietzner J, Borger MA, Fassl J, Haentschel D, Paarmann H et al.| title=The incidence of intraoperative awareness in cardiac surgery fast-track treatment. | journal=J Cardiothorac Vasc Anesth | year= 2010 | volume= 24 | issue= 5 | pages= 785-9 | pmid=20537922 | doi=10.1053/j.jvca.2010.03.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20537922 }} </ref><ref name="pmid8968177">{{cite journal| author=Cheng DC, Karski J, Peniston C, Raveendran G, Asokumar B, Carroll J et al.| title=Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use. A prospective, randomized, controlled trial. | journal=Anesthesiology | year= 1996 | volume= 85 | issue= 6 | pages= 1300-10 | pmid=8968177 | doi= | pmc= | url= }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
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| '''1.''' The effectiveness of high thoracic epidural anesthesia/analgesia for routine analgesic use is uncertain.<ref name="pmid20052816">{{cite journal| author=Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT et al.| title=Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). | journal=Reg Anesth Pain Med | year= 2010 | volume= 35 | issue= 1 | pages= 64-101 | pmid=20052816 | doi= | pmc= | url= }} </ref><ref name="pmid12707123">{{cite journal| author=Murphy GS, Szokol JW, Marymont JH, Vender JS, Avram MJ, Rosengart TK et al.| title=Recovery of neuromuscular function after cardiac surgery: pancuronium versus rocuronium. | journal=Anesth Analg | year= 2003 | volume= 96 | issue= 5 | pages= 1301-7, table of contents | pmid=12707123 | doi= | pmc= | url= }} </ref><ref name="pmid15851604">{{cite journal| author=Nygård E, Kofoed KF, Freiberg J, Holm S, Aldershvile J, Eliasen K et al.| title=Effects of high thoracic epidural analgesia on myocardial blood flow in patients with ischemic heart disease. | journal=Circulation | year= 2005 | volume= 111 | issue= 17 | pages= 2165-70 | pmid=15851604 | doi=10.1161/01.CIR.0000163551.33812.1A | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15851604 }} </ref><ref name="pmid18566197">{{cite journal| author=Tenenbein PK, Debrouwere R, Maguire D, Duke PC, Muirhead B, Enns J et al.| title=Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery. | journal=Can J Anaesth | year= 2008 | volume= 55 | issue= 6 | pages= 344-50 | pmid=18566197 | doi=10.1007/BF03021489 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18566197 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''.
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| ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III: HARM]]===
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| '''1.''' [[Cyclooxygenase-2 inhibitors]] are not recommended for pain relief in the postoperative period after CABG. <ref name="pmid15713945">{{cite journal| author=Nussmeier NA, Whelton AA, Brown MT, Langford RM, Hoeft A, Parlow JL et al.| title=Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 11 | pages= 1081-91 | pmid=15713945 | doi=10.1056/NEJMoa050330 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15713945 }} </ref><ref name="pmid12830070">{{cite journal| author=Ott E, Nussmeier NA, Duke PC, Feneck RO, Alston RP, Snabes MC et al.| title=Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery. | journal=J Thorac Cardiovasc Surg | year= 2003 | volume= 125 | issue= 6 | pages= 1481-92 | pmid=12830070 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12830070 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
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| '''2.''' Routine use of early extubation strategies in facilities with limited backup for airway emergencies or advanced respiratory support is potentially harmful. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.}}
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| ==Guideline Resources==
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| *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<ref name="pmid22064599">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=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. | journal=Circulation | year= 2011 | volume= | issue= | pages= | pmid=22064599 | doi=10.1161/CIR.0b013e31823c074e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22064599 }} </ref>.
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| ==References==
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| {{reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category:Cardiac surgery]]
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| [[Category:Cardiology]]
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| [[Category:Surgery]]
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| [[Category:Surgical procedures]]
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| [[Category:Up-To-Date]]
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| [[Category:Up-To-Date cardiology]]
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