ICU Management Following Thoracic Aorta Surgery

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

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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
    • 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

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Last updated: April 22, 2010

Citation

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TY - ELEC T1 - ICU Management Following Thoracic Aorta Surgery ID - 534221 Y1 - 2010/04/22/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534221/all/ICU_Management_Following_Thoracic_Aorta_Surgery PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -