Patologìâ (Apr 2025)
Ensuring optimal metabolism during coronary artery bypass grafting with cardiopulmonary bypass
Abstract
Aim: to reduce perioperative complications in cardiac surgeries with cardiopulmonary bypass (CPB) by developing a comprehensive, personalized approach to ensure optimal tissue metabolism. Materials and methods. A comprehensive approach to metabolic monitoring and correction was tested on 25 patients who underwent minimally invasive coronary artery bypass grafting under CPB conditions. As a component of multimodal analgesia, Pectoralis Plane Nerve Block I (PEC I) and Pectoralis Plane Nerve Block II (PEC II) were performed. For energy monitoring, a computer program titled “Energy Monitoring During Cardiac Surgery” was developed. This program allows for the assessment of the degree of metabolic disturbances in real time and facilitates timely adjustments in therapeutic strategy. The study was divided into three stages: Stage 1 – pre-CPB, Stage 2 – during CPB, and Stage 3 – post-CPB. Results. The functionality of the program was demonstrated using the case of a patient who underwent minimally invasive triple-vessel coronary artery bypass grafting. At Stage 1, the patient’s baseline condition showed metabolic strain despite normal hemodynamic parameters. Performing PEC I and PEC II blocks improved the patient’s metabolic status. During CPB, metabolism could be influenced by factors such as the composition and volume of the priming solution for the extracorporeal circuit, hemoglobin levels, perfusion index, gas-air mixture flow rate, patient body temperature, acid-base balance of the blood, and pharmacological regulation of vascular tone. Post-CPB, the indication for the use of sympathomimetics was a decrease in oxygen delivery and worsening metabolic parameters. Conclusions. The use of the “Energy Monitoring During Cardiac Surgery” program enables real-time assessment of a patient’s metabolic needs, allowing for informed decisions regarding therapeutic adjustments at all stages of the surgical intervention. Performing PEC I and PEC II blocks contributes to improved metabolism by reducing the severity of metabolic disturbances.
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