ICU Management Following Cardiac Surgery

ICU Management Following Cardiac Surgery is a topic covered in the Pocket ICU Management.

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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 drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:

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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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Last updated: April 22, 2010

Citation

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TY - ELEC T1 - ICU Management Following Cardiac Surgery ID - 534220 Y1 - 2010/04/22/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534220/all/ICU_Management_Following_Cardiac_Surgery PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -