Anesthesia for Cardiac Surgery - Preoperative Assessment for Cardiac Surgery
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pertinent to the cardiac procedure
Issues pertinent to the cardiac procedure and the physiologic impact of CPB and circulatory arrest include the following:
- Prior surgery in the chest, which technically complicates surgery
- Evidence of aortic and cerebrovascular disease—symptomatic or documented carotid arterial disease may warrant endarterectomy beforehand. Aortic disease can affect cannulation strategies for bypass and may sometimes require concomitant repair with the cardiac operation.
- History of bleeding, anticoagulation regimens, and prothrombotic tendencies may reveal a condition responsive to perioperative therapy.
- A history of heparin-induced thrombocytopenia (HIT) alerts to the potential for the development of life-threatening thrombotic complications when exposed to heparin. See section on anticoagulation for cannulation and bypass for management of patients with HIT.
- Renal insufficiency may indicate the need for intraoperative renal protective measures.
- Patients with pulmonary disease can develop severe post-CPB pulmonary dysfunction and may benefit from preoperative antibiotics, bronchodilators, steroids, or chest physical therapy.
- Liver dysfunction (e.g., cardiac cirrhosis) may indicate derangements in coagulation and platelet function and the need for transfusion of coagulation factors, platelets, and fibrinogen.