Anesthetic management
bleeding, abnormal coagulation, arrhythmia, blood loss, myocardial ischemia, infections, pain
BLEEDING, ABNORMAL COAGULATION, ARRHYTHMIA, BLOOD LOSS, SURGICAL SITE INFECTION, MYOCARDIAL ISCHEMIA, INFECTIONS
Anesthesia induction and maintenance were similar for all patients and consisted of sevoflurane, fentanyl, rocuronium, and propofol. Cefuroxime was used perioperatively for surgical site infection prophylaxis. Volume-controlled ventilation intraoperatively and after surgery was provided at a fraction of inspired oxygen of 0.5, a tidal volume of 6 to 8 mL/kg, a respiratory rate of 12 to 14 breaths/min, and positive end-expiratory pressure of 5 cmHNonpulsatile CPB mode was used with a perfusion index of 2.4 to 2.8 L/min/mMean arterial pressure (MAP) during CPB was maintained between 70 and 80 mmHg by administration of phenylephrine when necessary. For myocardial protection, 2,000 mL (single dose) of ice-cold (4 °C-6 °C) cardioplegic solution (Custodiol; HTK-Bretschneider, Dr. Franz Kohler Chemie GmbH, Bensheim, Germany) was delivered antegradely. At the termination of CPB, heparin was reversed using protamine sulfate at a ratio of 1:1. Steroids and aprotinin were not used. Packed red blood cells were administered when hemoglobin level dropped to < 8 g/dL. Fresh frozen plasma was transfused in cases of ongoing bleeding (150 mL/h blood loss over a 2-h period) based on abnormal coagulation parameters.Inotropic support (epinephrine, dobutamine) was guided by hemodynamic data (eg, cardiac index < 2.0 L/min/mAfter surgery, all patients were transferred to the ICU. Patients were transferred from the ICU to the ward after meeting the following criteria: fully oriented; arterial oxygen saturation > 90% on room air; no episodes of severe arrhythmia; absence of bleeding; diuresis > 0.5 mL/kg/h; no need for inotropes and/or vasopressors; and no signs of myocardial ischemia on electrocardiography.Patients were discharged from hospital when they met the following criteria: hemodynamic stability; independent ambulation and feeding; afebrile with no obvious infections; normal voiding and bowel function; pain control on oral medication(s); and able to tolerate exercise.