Anesthesia with Medical Diseases
A 52 year old male diagnosed as triple vessel coronary artery disease with poor left ventricular function. Coronary artery bypass grafting surgery was decided. During maintenance of anaesthesia which one of the following agents should be preferred? (AJIMS Nov 12)
'A> b' IV opioids > Isoflurane [Ref Morgan 4lh/e p. 462, 509]
a. Now the anaesthetic technique of choice for coronary artery bypass grafting is mixed intravenous / inhalation anaesthesia, i.e. :-
- Induction by intravenous anaesthetics (Propofol or etomidate) along with opioids.
- Maintenance by inhalational agent (lsoflurane, sevoflurane or desflurane) along with opioid.
b. So, opioids are used during induction as well as during maintenance, therefore best answer ofthis question. However, you should keep in mind that High-dose opioid anaesthesia, which was previously used widely in patients with significant vascular dysfunction, is not used now. The anaesthesia of choice is combined intravenous - inhalation anaesthesia.