The treatment of coronary artery disease (CAD) has evolved rapidly over the last two decades. The gold standard of surgical revascularization has been challenged by the development of balloon angioplasty catheters. Angioplasty was popularized in the United States in the early eighties in Atlanta, by Dr. Andreas Gruentzig who originally developed the procedure when he was working in Europe. Competition between Cardiologists and Cardiac Surgeons for patients with CAD has again intensified with the emergence of beating heart coronary artery bypass (CAB), which avoids the complications associated with cardiopulmonary bypass (CPB), yet offers the patient the benefit of long-term graft patency that greatly exceeds that of current endovascular technologies.1 The challenge now rests with the surgical community to effectively reduce the invasiveness of revascularization, yet maintain the benefits of long-term patency.
Evolution of Cardiac Anesthesia
Since the early days of cardiac surgery, anesthesia has continued to evolve. The introduction of shorter-acting agents that cause less hemodynamic instability has facilitated the "fast tracking" of patients. The temporal evolution of cardiac anesthesiology is as follows:
The purpose of this monograph is to review the major aspects of the anesthesiologistís role in the management and monitoring of the patient during beating heart surgery.