Anesthetic management during minimally invasive cardiac surgery with the Port-Access system for closure of atrial septal defect.

Abstract

a ratio of pulmonary to systemic blood flow (Qp/Qs) of 2.7 6 0.9 and a pulmonary artery mean pressure of 15 6 3mmHg (mean 6 standard deviation) (Table 1). All patients underwent preoperative assessment of the aorta, iliac arteries, and femoral arteries by angiography. The patients were premedicated with oral diazepam (5mg) and intramuscular pethidine (35mg) and atropine (0.5mg). Anesthesia was induced by intravenous administration of midazolam (2 to 4mg), fentanyl (5μg·kg21), and vecuronium (0.15mg·kg21), followed by endotracheal intubation with a standard single-lumen tube. Anesthesia was maintained with sevoflurane and nitrous oxide in oxygen in combination with fentanyl (15 to 20μg·kg21 in total), propofol, and vecuronium. Nitrous oxide was used only before CPB, and propofol was infused continuously during CPB at 4mg·kg21·h21. Intraoperative monitoring included five-lead electrocardiography, pulse oximetry, capnography, urinary output measurement, and nasopharyngeal and bladder temperature. After the induction of anesthesia, the bilateral brachial arteries were cannulated to measure the pressure difference, and a central venous catheter was inserted through the right internal jugular vein. In our institution, we usually use the brachial artery for intravascular blood pressure measurement, since the brachial artery can provide more accurate estimation of aortic pressure than the radial artery [4,5]. Simultaneously, a 5Fr sheath was placed in the right internal jugular vein by the anesthesiologist. A transesophageal echocardiography (TEE) probe was placed. TEE examination was performed to determine the diameter of the ascending aorta and to exclude severe atherosclerosis of the ascending and descending aorta as well as major aortic valve insufficiency. Defibrillator pads were placed over the right lateral and left posterior chest wall. The Port-Access cannulae/catheter-based system (Endovascular CPB system: Heartport) consists of a set