ICU Management Following Cardiac Surgery
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Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drugs, procedures, and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and PRIME Journals. Explore these free sample topics:
-- The first section of this topic is shown below --
First Things First
- Get report from surgery/anesthesia team and assess for the following:
Airway
- Security and depth of ETT upon arrival
- Difficulties with intubation
Oxygenation
- Oximetric saturation and PaO2 for a given amount of FiO2 and PEEP
Ventilation
- pH and pCO2 for a given tidal volume, respiratory rate and peak inspiratory pressure
Hemodynamics
- MAP, SBP and DBP, as supported by
- CO, SVR, CVP, PAOP/PAD, rhythm
- Hemodynamically active drug infusions
- Correlation of filling pressures with ventricular dimensions on 2D TEE
- Intraoperative segmental wall motion abnormalities
- Intraoperative TEE assessment of native valves, replaced/repaired valves
- ASD or VSD?
- IABP timing and adequacy of both systolic and diastolic augmentation
- General function of LVAD, RVAD or BIVAD
Temperature
- Bladder and core (intravascular) temperature
- Degree to which patient was cooled and subsequently warmed intraoperatively
Fluids, electrolytes and renal function
- Intraoperative measures of electrolytes (most notably last values for potassium)
- Total fluids and blood products
- Intraoperative urine output
Hematological (oxygen carrying capacity)
- Estimates of blood loss
- Salvaged blood returned
- Total PRBC products administered
Hematological (capacity to clot)
- ACT
- Prebypass
- Post heparin
- Postbypass
- Post protamine
- Amount of heparin administered in total, types and amounts of non-PRBC blood products (platelets, FFP, cryoprecipitate)
- Hematologically active drugs administered (aminocaproic acid, tranexemic acid, DDAVP)
Nutrition
- Intraoperative blood glucoses
- Amount and route of insulin given
- Infectious disease defenses
- Timing and dose of perioperative antibiotics
Anesthesia
- Type, timing and doses of:
- Narcotics, benzodiazepines
- Neuromuscular blocking agents,
- Volatile anesthetics, intravenous anesthetics
Surgical specifics
- Bypass grafts
- Number
- Location
- Types performed (vein, radial, mammary, etc.)
- Any portion of diseased coronary circulation not amenable to bypass
- Type and location of valvular replacement/repair
- Total CPB time, total cross-clamp time
-- To view the remaining sections of this topic, please log in or purchase a subscription --
First Things First
- Get report from surgery/anesthesia team and assess for the following:
Airway
- Security and depth of ETT upon arrival
- Difficulties with intubation
Oxygenation
- Oximetric saturation and PaO2 for a given amount of FiO2 and PEEP
Ventilation
- pH and pCO2 for a given tidal volume, respiratory rate and peak inspiratory pressure
Hemodynamics
- MAP, SBP and DBP, as supported by
- CO, SVR, CVP, PAOP/PAD, rhythm
- Hemodynamically active drug infusions
- Correlation of filling pressures with ventricular dimensions on 2D TEE
- Intraoperative segmental wall motion abnormalities
- Intraoperative TEE assessment of native valves, replaced/repaired valves
- ASD or VSD?
- IABP timing and adequacy of both systolic and diastolic augmentation
- General function of LVAD, RVAD or BIVAD
Temperature
- Bladder and core (intravascular) temperature
- Degree to which patient was cooled and subsequently warmed intraoperatively
Fluids, electrolytes and renal function
- Intraoperative measures of electrolytes (most notably last values for potassium)
- Total fluids and blood products
- Intraoperative urine output
Hematological (oxygen carrying capacity)
- Estimates of blood loss
- Salvaged blood returned
- Total PRBC products administered
Hematological (capacity to clot)
- ACT
- Prebypass
- Post heparin
- Postbypass
- Post protamine
- Amount of heparin administered in total, types and amounts of non-PRBC blood products (platelets, FFP, cryoprecipitate)
- Hematologically active drugs administered (aminocaproic acid, tranexemic acid, DDAVP)
Nutrition
- Intraoperative blood glucoses
- Amount and route of insulin given
- Infectious disease defenses
- Timing and dose of perioperative antibiotics
Anesthesia
- Type, timing and doses of:
- Narcotics, benzodiazepines
- Neuromuscular blocking agents,
- Volatile anesthetics, intravenous anesthetics
Surgical specifics
- Bypass grafts
- Number
- Location
- Types performed (vein, radial, mammary, etc.)
- Any portion of diseased coronary circulation not amenable to bypass
- Type and location of valvular replacement/repair
- Total CPB time, total cross-clamp time
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