For the patient undergoing CPB and AV replacement, general anesthesia with endotracheal intubation is necessary. Opioids and IV and inhalation anesthetics can be safely administered, with careful attention to hemodynamics. Increasingly, anesthetic techniques for cardiac surgery are structured to optimize perioperative outcomes, and avoid the adverse effects of opioids and prolonged intubation. Enhanced Recovery after Cardiac Surgery (ERACS) programs emphasize the use of regional anesthesia, opioid-sparing analgesics, and readily reversible neuromuscular blockade to help reduce postoperative morbidity. These synergistic strategies can be particularly beneficial for high-risk surgical patients.

References

• Barry AE, Chaney MA, London MJ. Anesthetic management during cardiopulmonary bypass: a systematic review. Anesth Analg. 2015;120:749-769.
• Baxter R, Squiers J, Conner W, et al. Enhanced recovery after surgery: a narrative review of its application in cardiac surgery. Ann Thorac Surg. 2020;109:1937-1944.
• Grant MC, Isada T, Ruzankin P, et al. Opioid-sparing cardiac anesthesia: secondary analysis of an enhanced recovery program for cardiac surgery. Anesth Analg. 2020;131:1852-1861.
• Kelava M, Alfirevic A, Bustamante S, Hargrave J, Marciniak D. Regional anesthesia in cardiac surgery: an overview of fascial plane chest wall blocks. Anesth Analg. 2020;131:127-135.