Anesthetic management of concomitant off-pump coronary artery bypass grafting, pulmonary resection, and mastectomy

Recently, an increasing number of patients with both ischemic heart disease and malignancy have underwent cardiac surgery and other operations simultaneously, as indication of off-pump coronary artery bypass grafting (OPCAB) has been expanded. A 66-year-old woman underwent OPCAB and other two operations for malignant diseases. General anesthesia was maintained by total intravenous infusion of propofol and fentanyl, and the patient's hemodynamics were kept stable throughout the operation under continuous administration of cardiotonics: dopamine, norepinephrine, and milrinone. The procedure for the operations was discussed in a conference with surgeons: 1. OPCAB 2. right middle and lower lobectomy and 3. right mastectomy. There were no postoperative complications.