Endoscopic Coronary Artery Bypass Graft

Goals:
1. Normotensive
2. Normothermic
3. Maintain normal electrolytes
4. Avoid tachycardia or bradycardia

Approach:
Left thorocoscopic for dissection of left internal mammary artery.
Left parasternal thoracotomy in 4th intercostal space for LIMA to LAD aastamosis.

Requirements:
1. Venous access and radial arterial line in right hand
2. One lung ventilation. Left lung can be collapsed either with double lumen tube or use of broncial blocker with single lumen tube.
3. Left internal jugular access.
4. External warming device.
5. Perfusionist fully prepared for CPB if required.
6. Heparin just before clamping the LIMA, half to full dose depending on the local practice.
7. Post op pain relief - PCA morphine is what we ususlly follow. Other options include - thoracic epidural, PCA alfentanil.