Anesthesia in patient with low cardiac output undergoing Coronary Artery Bypass Grafting surgery

The number of patients with elderly age and heart failure presenting for surgery continues to rise, due to increase in life span, and anesthesiologists are called upon to provide quality, safe care in the operating room for the patients with low ejection fraction (EF). EF is an important measurement in determining how well the heart is pumping out blood and in diagnosing as well as tracking the heart failure (HF). Normal EF varies at 55% to 70%, while EF 40% to 55% may indicate damage perhaps from previous heart attack, but may not indicate HF. However, measurement under 40% may show evidence of HF or cardiomyopathy; and patient with EF< 35% may be at the risk of life threatening irregular heartbeats. Such patients are considered to be at high risk for anesthesia as life threatening irregular heartbeats lead to sudden cardiac arrest and sudden death. Objectives in the anesthetic management of these patients include maintaining forward flow, promoting adequate heart rate, avoidance of arrhythmias and maintaining stable condition in the postoperative period. Sometimes anesthesia requires invasive cardiovascular monitoring; ultimately the skill with which anesthesia technique is selected and delivered determines the outcome of the patient.