[Ideal intraoperative management to prevent perioperative complications]

Anesthesiologists can contribute considerably to prevent both intra- and post-operative complications. Intraoperative transesophageal echocardiography can be utilized to visualize potential hazards at various stages in cardiac surgery; aortic and venous cannulation, left ventricular vent tube insertion and removal of residual air in cardiac chambers. Near infrared spectroscopy is employed for early detection of cerebral ischemia. A more than 20 percent of decrease from the preoperative baseline probably indicates cerebral ischemia and prompts some measures to improve cerebral oxygenation. Separate lung ventilation can be offered by using a combination of a normal endotracheal tube and a bronchial blocker instead of a double lumen tube in order to avoid a tube exchange at the end of operation which is sometimes difficult and dangerous. Intraoperative awareness should be avoided by administering additional sedatives especially at a rewarming phase of cardiopulmonary bypass. Intraoperative shivering causes excessive oxygen demands and should be prevented by giving enough amounts of muscle relaxants. Temperature and glucose controls are also important to decrease surgery-related morbidity and mortality. A premature cease of rewarming by cardiopulmonary bypass and extra heating after bypass may well be considered. High thoracic epidural anesthesia is possibly beneficial to reduce patients' stress, improve postoperative pulmonary function and hasten recovery.