Physiology-Guided Anesthetic Management for Off-Pump Coronary Artery Bypass Without Advanced Monitoring: A...

To evaluate the feasibility of a physiology-guided anesthetic strategy for off-pump coronary artery bypass (OPCAB) without advanced hemodynamic monitoring.

Retrospective observational cohort study.

Single tertiary cardiac center in a resource-limited setting.

Fifty-two adult patients undergoing elective OPCAB.

A structured anesthesia protocol targeting mean arterial pressure ≥70 mmHg using preload optimization and norepinephrine without advanced monitoring.

The majority of patients were extubated within 4 ± 2 hours after surgery, and 94.3% had an intensive care unit stay of ≤2 days, reflecting an effective fast-track recovery profile. Hemodynamic instability, managed with norepinephrine and Trendelenburg positioning, occurred primarily during posterior wall exposure. Conversion to cardiopulmonary bypass occurred in 1.9%. Arrhythmias occurred in 19.3%, predominantly transient. Postoperative complications included atrial fibrillation (7.7%) and acute kidney injury (5.7%). Thirty-day mortality was 1.9%.

A physiology-guided anesthetic strategy appears feasible and may allow acceptable perioperative outcomes in OPCAB performed in resource-limited settings without advanced hemodynamic monitoring.