Intra-operative care
During off-pump surgeries, stable hemodynamics are crucial. We opened
the pericardium in an inverted-T fashion and added a vertical incision
to the inferior surface to expand the pericardial cavity in the lateral
dimension. This prevents right-side heart kinking when located in a
standing position. We used phenylephrine as needed to maintain systemic
blood pressure and excessive volume infusion was avoided where possible,
to prevent post-operative edema or deterioration of oxygenation.
Hemodynamics are monitored with Swan-Ganz catheter including pulmonary
artery pressure, mixed venous oxygen saturation and cardiac output.
General anesthesia was maintained by inhaled anesthesia after anesthetic
induction. As a muscle relaxant, rocuronium bromide was continuously
infused at a specific dose according to the bodyweight of the patient,
and was reversed with sugammadex when post-operative hemodynamic
stability was confirmed.