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
  • Type of aneurysm repaired (DeBakey and/or Stanford classifications)
  • Type of aortic graft placed
  • Type and number of bypass grafts
  • Type and location of valvular replacement or repair
  • Total time on one-lung ventilation
  • 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, total circulatory arrest time
  • Type of bypass (full vs. partial and, if partial, which type)
  • Perfusion pressure of lower vs. upper extremities during partial bypass
• Measures employed for cerebral and/or spinal cord protection