Anesthetic Management in Combined Off-Pump CABG and EC-IC Bypass for CAD and Moyamoya Disease.

BACKGROUND

Surgical treatment of moyamoya disease combined with coronary heart disease presents unique anesthetic challenges.

CASE SUMMARY: A 56-year-old woman underwent combined off-pump coronary artery bypass grafting and extracranial-intracranial arterial bypass surgery. The challenges in this surgery included maintaining cerebral oxygenation (regional cerebral oxygen saturation: >75% of baseline), controlled heart rate (60-70 beats/min), lung-protective ventilation (partial arterial pressure of carbon dioxide: 40-45 mm Hg), and mean arterial pressure >70 mm Hg. The patient experienced 2 intraoperative emergencies: hypotension and cerebral oxygen desaturation. The first episode was caused by cardiac displacement and was managed with fluid resuscitation and norepinephrine. The second episode likely resulted from myocardial ischemia-reperfusion injury and was treated with inotropes and coronary vasodilators.

DISCUSSION: The key to anesthetic management in combined heart-brain surgery lies in balancing the heart-brain perfusion conflict while integrating cerebral function monitoring and myocardial protection.