Postoperative Care of the Cardiac Surgical Patient
KEY POINTS 1. Transport from the operating room (OR) to the intensive care unit (ICU) is a critical period for patient monitoring or vigilance. Emergency drugs and airway equipment should…
ANESTHESIA
Blood Transfusion
KEY POINTS 1. Both anemia and transfusion carry significant risks. Balancing these risks is the key to appropriate blood transfusion decisions. 2. Despite published guidelines about transfusion, clinical transfusion practice…
Intraoperative Myocardial Protection
KEY POINTS 1. Mechanisms of myocardial ischemic injury are multifactorial and include some of the following: Depletion of high-energy phosphates, intracellular acidosis, alterations in intracellular calcium homeostasis, complement activation, generation…
Anesthetic Management in the Precardiopulmonary Bypass Period
KEY POINTS 1. The incidence of ischemia during this period has been reported to be 7% to 56%. 2. The Society of Thoracic Surgeons recommends a cephalosporin as the primary…
Devices for Cardiac Support and Replacement
KEY POINTS 1. Mechanical circulatory support devices most often are ventricular assist devices, which are indicated for bridging to myocardial recovery or cardiac transplantation or as a permanent assist device…
Anesthetic Management during Cardiopulmonary Bypass
KEY POINTS 1. Prior to cannulation for cardiopulmonary bypass (CPB), the anesthesiologist must assure that adequate heparin-induced anticoagulation has been achieved, which is typically diagnosed as an activated clotting time…
Cardiovascular Physiology: A Primer
KEY POINTS 1. The heart has a fibrous skeleton that provides an insertion site at each valvular ring. This fibrous structure also connects cardiac myocytes so that “stretch” or preload…
Pain Management for Cardiothoracic Procedures
KEY POINTS 1. Chronic pain due to intercostal nerve injury develops in approximately 50% of postthoracotomy patients, and in 5% this pain becomes severe and disabling. 2. Thoracic epidural analgesia…
The Postcardiopulmonary Bypass Period: Weaning to ICU Transport
KEY POINTS 1. Core temperature (nasopharyngeal or tympanic membrane) should be greater than 36°C before terminating cardiopulmonary bypass (CPB). However, the nasopharyngeal temperature should not exceed 37°C, as this will…
Induction of Anesthesia
KEY POINTS 1. On the day of surgery, most cardiovascular medications should be administered orally, with the exceptions of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and (selectively) diuretic agents….
