Coronary artery disease and anaesthesia (Experience in 120 patients for revascularization of the heart)

Abstract

One-hundred and twenty patients with severe coronary artery disease were anaesthetized for a revascularization procedure. The over-all mortality rate was 13.4 per cent. The preoperative assessment, anaesthetic management and postoperative care of these patients have been described. The experience has been helpful in managing patients with coronary artery disease for any type of surgery. A normal electrocardiogram at rest is of no value in predicting the severity of coronary artery disease. It was normal in three of 16 men who died, and severe disease was demonstrated in these patients. Hypotension was avoided as far as possible by meticulous attention to the anaesthetic technique, fluid and blood replacement. When hypotension occurred it was immediately corrected by the judicious use of phenylephrine. Angina at rest without exciting cause was the most important single factor that could be related to mortality. The mortality in patients with angina grade II (angina at rest without exciting cause) was 32.2 per cent as compared to 5.8 per cent in patients with angina grade I ( angina other than grade II ). Two patients had had a clinical infarct six months before surgery with angina grade I and both died in the operating room. Two patients at autopsy were found to have had an undiagnosed infarct two to three weeks prior to surgery. Associated diseases which contributed to mortality were hypertension, diabetes and myxedema, cerebral vascular insufficiency, pulmonary insufficiency, and digitalis intoxication associated with hypokalaemia. © 1967 Canadian Anesthesiologists.