Anaes · Cardiac anaesthesia
CABG anaesthesia: on-pump and off-pump
Also known as CABG anaesthesia: on-pump and off-pump · OPCAB anaesthesia · On-pump coronary bypass
Exam-exhaustive anaesthesia for CABG including on-pump CPB goals, heparin and ACT targets, OPCAB haemodynamics with stabilisers, conversion readiness, grafting sequence, TOE-guided optimisation, and TRICS III transfusion context.
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10 MCQs with explanations
Target exams
Red flags
Meet the patient
A 68-year-old diabetic with three-vessel disease and an ejection fraction of 35 percent is listed for CABG. The surgeon proposes off-pump to avoid the inflammatory hit of cardiopulmonary bypass. But a lateral-wall graft on a beating heart means verticalising and compressing a ventricle that is already struggling — and the perfusionist is standing by in case the blood pressure collapses.[2]
The discriminator on this topic is whether you can quote the exact heparin-ACT-protamine numbers for on-pump work and describe the conversion ladder for OPCAB without hesitation. Both techniques share TOE as the integrating monitor, and both end in the cardiac ICU with fast-track targets.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Anaesthesia fellowship atlas.
References3Show ledgerHide ledger
- [1]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery N Engl J Med, 2017.PMID 29130845
- [2]Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists J Am Soc Echocardiogr, 2013.PMID 23998692
- [3]Levy JH, et al. What's fishy about protamine? Clinical use, adverse reactions, and potential alternatives J Thromb Haemost, 2023.PMID 37062523