Postoperative pulmonary complications after conventional coronary artery bypass grafting

Despite numerous advances in anesthesia, surgical techniques, and postoperative care for coronary artery bypass graft (CABG) surgery, postoperative pulmonary complications (PPCs) still account for postoperative morbidity. Postoperative lung injury is one of the most frequent complications of cardiac surgery. This complication mostly results from the use of cardiopulmonary bypass (CPB). However, recent comparative studies between conventional and off-pump coronary artery bypass grafting have indicated that CPB itself may not be the major contributor to the development of postoperative pulmonary dysfunction. Thus the patophysiology of described complication is not clearly defined. We present the most frequent complication that can be observed after coronary bypass surgery. Pulmonary complications are seen by anesthesiologists, cardiac surgeons and rehabilitants during the postoperative stay in the ward, and should also be considered as serious problem, in terms of the costs of stay during hospitalization. Appropriate diagnosis can result in the reducing of the adverse effects of coronary artery bypass grafting. Pleural effusion. Pleural effusion occurs often among patients after coronary artery bypass grafting, and is as high as 90% [1]. Pleural effusion are most commonly small and left sided, due to the harvesting of the left mammary artery, as the most frequent arterial conduit in cardiac surgery [2]. Small effusions are generally insignificant and resolve spontaneously. Larger volumes can cause respiratory compromise by reducing the effective volume of ventilation. Bloody pleural effusions usually occur earlier and are associated with a higher lactic acid dehydrogenase level and are eosynophilic [3]. Postoperative hemothorax is more common in patients undergoing internal mammary artery grafting. Most of the postoperative effusions are managed with observation alone. Effusion that are medium-size and which are fail to resolve spontaneously should be sampled by thoracocentesis. If the fluid obtained suggest hemothorax or infection tube drainage is required [4]. (Clin Exp Med Lett 2008; 49(1): 1-3)

Keywords: CABG, pulmonary, Cardiopulmonary Bypass, atelectasis