Dr Vikram Arora has completed his MD in 2010 a er that he worked for a year in For s Escorts hospital, okhla N. delhi as senior resident. He completed his fellowship in cardiac anaesthesia from For s hospital, Mohali. He was trained in both adult and paediatric cardiac cases. He was also trained in transoesophageal echocardiography during his fellowship period. He worked as A ending consultant in For s Hospital, Mohali. Than from 2014-2018 he joined Max super Speciality Hospital as Associate Consultant. He joined as Consultant Cardiac Anaesthesia from April 2018 in IVY hospital Mohali. Dr Vikram has experience of over 2500 cardiac cases.

 

Off -pump coronary artery bypass (OPCAB) surgery has shown to have some advantages compared to on-pump cardiac surgery, par cularly the reduc on in postopera ve complica ons including systemic infl amma on, myocardial injury and cerebral injury. The anaesthesiologist has to deal with diff erent issues including hemodynamic instability and myocardial ischemia during aorto-coronary bypass gra ing. The anaesthesiologist and surgeon should collaborate and plan the best periopera ve strategy to provide op mal care and ensure a rapid and complete recovery. Off  pump CABG in poor LV func on is controversial. Preopera vely we stra fy pa ents according to euro score and manage accordingly. In poor LV & acute MI pateints were primarily induced with opioids anaesthe c agents and followed by slow extuba on guided by cardiac output and clinical 

state of pa ent. Intra-aor c balloon pump(IABP) was inserted according to pa ent’s preopera ve clinical state, pulmonary artery pressure or depending on coronary lesion anatomy. IABP is usually removed post extuba on guided by Pulmonary artery pressure monitoring and echocardiographic func oning of heart. Intra-aor c balloon pump was gradually weaned from 1:1 to 1:2 & 1:3, followed by reduc on in support of intra-aor c balloon pump volume. Poor LV func on pa ents are elec vely ven lated in our ins tute for Post-opera ve day 1 and are extubated on post-opera ve day 2. Intra-aor c balloon pump was removed by day 4 and usually these pa ents get discharged by pod 7. We would like to outline some protocols followed in our ins tu on for off  pump CABG in poor LV func on pa ents and acute myocardial infarcta on.