RT Book, Section
A1 Rozenfeld, Ranna A.
SR Print(0)
ID 1152488131
T1 Postoperative Management after Cardiac Surgery
T2 The PICU Handbook
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259834370
LK accesspediatrics.mhmedical.com/content.aspx?aid=1152488131
RD 2023/09/30
AB A  thorough  understanding  of  what  occurred  intraoperatively  is  critical  to  postoperative  management  after  cardiac  surgery.Cardiac  Anesthesia:Induction  technique  and  maintenance  of  anesthesia  depend  on  the  underlying  anatomic  defect,  cardiac  function,  and  degree/duration  of  sedation  required.  The  goal  is  to  minimize  hemodynamic  instability,  particularly  in  patients  with  low  cardiac  reserve.Premedication:  Often  utilizes  a  benzodiazepine  or  barbiturate  orally.Airway  management:  Skillful  manipulation  of  the  airway  and  management  of  ventilation  are  critical  to  minimize  unfavorable  cardiopulmonary  interactions.Induction  and  maintenance  of  anesthesia:  Wide  variety  of  agents  administered  alone  or  in  combination.  Neuromuscular  blockade  typically  utilizes  a  nondepolarizing  muscle  relaxant.Cardiopulmonary  Bypass  (CPB):  Cardiothoracic  surgery  may  be  performed  with  or  without  cardiopulmonary  bypass.Considerations  include  pump  prime  strategy  and  dilutional  effect  on  blood  volume,  use  of  hypothermia,  use  of  regional  low-flow  perfusion  or  circulatory  arrest,  use  of  modified  ultrafiltration  (MUF),  acid–base  strategy,  use  of  intraoperative  steroids.Sequelae  of  CPB  include  renal  dysfunction,  capillary  leak,  systemic  inflammation,  abnormal  glucose  regulation,  hemodilution,  and  neurologic  injury.Hemostasis:  Bleeding  is  often  a  problem  after  CPB  due  to  a  combination  of  systemic  anticoagulation,  platelet  dysfunction,  and  systemic  inflammation.  Intraoperative  concern  about  bleeding,  last  activated  clotting  time  (ACT),  and  blood  product  administration  should  be  quantified.  Assess  need  and  timing  for  postoperative  anticoagulation  (ex:  aspirin  for  shunt).Hemodynamics:  Mean  arterial  pressure  maintained  with  combination  of  CPB  and  vasoactive  medications.  Any  intraoperative  hemodynamic  instability  should  be  discussed  at  handoff.  Invasive  monitoring  devices  (arterial  lines,  intracardiac  lines,  central  venous  access,  Foley  catheter,  chest  tubes,  pacing  wires,  etc.)  placed  during  surgery  should  be  identified.Anatomic  Considerations:  Technical  aspects  of  the  surgical  repair  and  postoperative  cardiac  function  often  assessed  by  transesophageal  echocardiography  intraoperatively.