Perioperative safety in coronary artery bypass grafting: the role of the anesthesiologist.

PURPOSE OF REVIEW: As our population ages and cardiovascular disease increases in prevalence, a growing number of patients will be candidates for coronary artery bypass grafting (CABG). Outcomes from this common surgery can be improved by a coordinated team approach involving physicians, nurses, and healthcare professionals from multiple specialties. This review will discuss the role cardiovascular anesthesiologists play in the perioperative care of these complex patients.

RECENT FINDINGS: Cardiovascular anesthesiologists may play a variety of important roles throughout the entire perioperative period of patients undergoing CABG. This may include identification and optimization of preoperative comorbidities, employment of enhanced recovery pathways, perioperative echocardiographic assessment of complex cardiovascular states, management of patients on cardiopulmonary bypass, and others. There is growing evidence that each of these areas contributes to better care and improved outcomes.

SUMMARY: Care of the patient undergoing CABG requires a team approach. Optimal team dynamics translate into better care for patients and improved outcomes. The cardiovascular anesthesiologist is an integral member of this team whose role is central in the coordination of all aspects of perioperative care. Preoperative optimization begins the process, which continues throughout surgery, cardiopulmonary bypass, and into the postoperative period.