Advertisement

Postoperative Care

  • Bradley J. Harlan
  • Albert Starr
  • Fredic M. Harwin
  • Alain Carpentier
Chapter

Abstract

Postoperative care has evolved over the years into a scientific method of maintaining desirable physiologic states or changing abnormal states. This chapter discusses our routine postoperative monitoring and therapy and reviews common problems occurring in the postoperative period, with an outline of our therapies.

Keywords

Cardiopulmonary Bypass Supraventricular Arrhythmia Prosthetic Valve Endocarditis Inspire Oxygen Concentration Intermittent Mandatory Ventilation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Angelini P, Feldman MI, Lufschanowski R, Leachman RD: Cardiac arrhythmias during and after heart surgery: diagnosis and management. Prog Cardiovasc Dis 16:469,1974.PubMedCrossRefGoogle Scholar
  2. 2.
    Ansell J, Klassen V, Lew R, Ball S, Weinstein M, VanderSalm T, Okike N, Gratz I, Leslie J, Roberts A, Fleming N, Salzman P: Does desmopressin acetate prophylaxis reduce blood loss after valvular heart operations? J Thorac Cardiovasc Surg 104:117,1992.PubMedGoogle Scholar
  3. 3.
    Bernstein JG, Koch-Weser J: Effectiveness of bretylium tosylate against refractory ventricular arrhythmias. Circulation 45:1024,1972.PubMedGoogle Scholar
  4. 4.
    Blauth CI, Cosgrove DM, Webb BW, Ratliff NB, Boylan M, Piemonte MR, Lytle BW, Loop FD: Atheroembolism from the ascending aorta: an emerging problem in cardiac surgery. J Thorac Cardiovasc Surg 103:1104,1992.PubMedGoogle Scholar
  5. 5.
    Corwin HL, Sprague SM, DeLaria GA, Norusis MJ: Acute renal failure associated with cardiac operations. J Thorac Cardiovasc Surg 98:1107,1989.PubMedGoogle Scholar
  6. 6.
    Culliford AT, Cunningham JN Jr, Zeff RH, Isom OW, Teiko P, Spencer FC: Sternal and costochondral infections following open-heart surgery: a review of 2,594 cases. J Thorac Cardiovasc Surg 72:714,1976.PubMedGoogle Scholar
  7. 7.
    Czer LSC, Bateman TM, Gray RJ, Raymond M, Stewart ME, Lee S, Goldfinger D, Chaux A, Matloff JM: Treatment of severe platelet dysfunction and hemorrhage after cardiopulmonary bypass: Reduction in blood product usage with desmopressin. J Am Coll Cardiol 9:1139,1987.PubMedCrossRefGoogle Scholar
  8. 8.
    Davis RF, Lappas DG, Kirklin JK, Buckley MJ, Lowenstein E: Acute oliguria after cardiopulmonary bypass: renal functional improvement with low-dose dopamine infusion. Crit Care Med 10:852,1982.PubMedCrossRefGoogle Scholar
  9. 9.
    Downs JB, Klein EF Jr, Desautels D, Modell JH, Kirby RR: Intermittent mandatory ventilation: a new approach to weaning patients from mechanical ventilators. Chest 64:331,1973.PubMedCrossRefGoogle Scholar
  10. 10.
    Engle MA, Ito T: The postpericardiotomy syndrome. Am J Cardiol 7:73,1961.PubMedCrossRefGoogle Scholar
  11. 11.
    Engle MA, McCabe JC, Ebert PA, Zabriskie J: The postpericardiotomy syndrome and antiheart antibodies. Circulation 49:401,1974.PubMedGoogle Scholar
  12. 12.
    Fraser DG, Ullyot DJ: Mediastinal tamponade after open-heart surgery. J Thorac Cardiovasc Surg 66:629,1973.PubMedGoogle Scholar
  13. 13.
    Fremes SE, Weisel RD, Mickle DAG, Teasdale SJ, Aylmer AP, Christakis GT, Madonik MM, Ivanov J, Houle S, McLaughlin PR, Baird RJ: A comparison of nitroglycerin and nitroprusside: I. Treatment of postoperative hypertension. Ann Thorac Surg 39:53,1985.PubMedCrossRefGoogle Scholar
  14. 14.
    Gailiunas P Jr, Chawla R, Lazarus JM, Cohn L, Sanders J, Merrill JP: Acute renal failure following cardiac operations. J Thorac Cardiovasc Surg 79:241,1980.PubMedGoogle Scholar
  15. 15.
    Gray RJ: Postcardiac surgical hypertension. J Cardiothorac Anesth 2:678,1988.PubMedCrossRefGoogle Scholar
  16. 16.
    Hackmann T, Gascoyne RD, Naiman SC, Growe GH, Burchill LD, Jamieson WRE, Sheps SB, Schechter MT, Townsend GE: A trial of desmopressin (1-desamino-8-d-arginine vasopressin) to reduce blood loss in uncomplicated cardiac surgery. N Engl J Med 321:1437,1989.PubMedCrossRefGoogle Scholar
  17. 17.
    Hodam RP, Starr A: Temporary postoperative epicardial pacing electrodes, their value and management after open-heart surgery. Ann Thorac Surg 8:506,1969.PubMedCrossRefGoogle Scholar
  18. 18.
    Huddy SPJ, Joyce WP, Pepper JR: Gastrointestinal complications in 4473 patients who underwent cardiopulmonary bypass surgery. Br J Surg 78:293,1991.PubMedCrossRefGoogle Scholar
  19. 19.
    Iverson LIG, Ecker RR, Fox HE, May IA: A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery. Ann Thorac Surg 25:197,1978.PubMedCrossRefGoogle Scholar
  20. 20.
    Jardin F, Farcot J, Boisante L, Curien N, Margairaz A, Bourdarias J: Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med 304:387,1981.PubMedCrossRefGoogle Scholar
  21. 21.
    Johnson RG, Rosenkrantz KR, Preston RA, Hopkins C, Daggett WM: The efficacy of postoperative autotransfusion in patients undergoing cardiac operations. Ann Thorac Surg 36:173,1983.PubMedCrossRefGoogle Scholar
  22. 22.
    Katz ES, Tunick PA, Rusinek H, Ribakove G, Spencer FC, Kronzon I: Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 20:70,1992.PubMedCrossRefGoogle Scholar
  23. 23.
    Klein EF Jr: Weaning from mechanical breathing with intermittent mandatory ventilation. Arch Surg 110:345,1975.PubMedGoogle Scholar
  24. 24.
    Koch-Weser J, Klein SW: Procaineamide dosage schedules, plasma concentrations, and clinical effects. JAMA 215:1454,1971.PubMedCrossRefGoogle Scholar
  25. 25.
    Lewis FR, Blaisdell W, Schlobohm RM: Incidence and outcome of posttraumatic respiratory failure. Arch Surg 112:436,1977.PubMedGoogle Scholar
  26. 26.
    Livelli FD Jr, Johnson RA, McEnany MT, Sherman E, Newell J, Block PC, DeSanctis RW: Unexplained in-hospital fever following cardiac surgery. Natural history, relationship to postpericardiotomy syndrome, and prospective study of therapy with indomethacin versus placebo. Circulation 57:968,1978.PubMedGoogle Scholar
  27. 27.
    Matloff JM, Wolfson S, Gorlin R, Harken DE: Control of postcardiac surgical tachycardias with propranolol. Circulation 37(Suppl II):II–133,1968.Google Scholar
  28. 28.
    Mazze RI: Critical care of the patient with acute renal failure. Anesthesiology 47:138,1977.PubMedCrossRefGoogle Scholar
  29. 29.
    McConnell DH, Maloney JV, Buckberg GD: Postoperative intermittent positive-pressure breathing treatments. J Thorac Cardiovasc Surg 68:944,1974.PubMedGoogle Scholar
  30. 30.
    McKowen RL, Magovern GJ, Liebler GA, Park SB, Bukholder JA, Maher TD: Infectious complications and cost-effectiveness of open resuscitation in the surgical intensive care unit after cardiac surgery. Ann Thorac Surg 40:388,1985.PubMedCrossRefGoogle Scholar
  31. 31.
    McLeish KR, Luft FC, Kleit SA: Factors affecting prognosis in acute renal failure following cardiac operations. Surg Gynecol Obstet 145:28,1977.PubMedGoogle Scholar
  32. 32.
    Mills NL, Everson CT: Atherosclerosis of the ascending aorta and coronary artery bypass: pathology, clinical correlates, and operative management. J Thorac Cardiovasc Surg 102:546,1991.PubMedGoogle Scholar
  33. 33.
    Plumb V, Karp RB, Kouchoukos NT, Zorn GL, James TN, Waldo AL: Verapamil therapy of atrial fibrillation and atrial flutter following cardiac operation. J Thorac Cardiovasc Surg 83:590,1982.PubMedGoogle Scholar
  34. 34.
    Porter GA, Starr A: Management of postoperative renal failure following cardiovascular surgery. Surgery 65:390,1969.PubMedGoogle Scholar
  35. 35.
    Powers SR Jr, Mannal R, Neclerio M, English M, Marr C, Leather R, Ueda H, Williams G, Custead W, Dutton R: Physiologic consequences of positive end-expiratory pressure (PEEP) ventilation. Ann Surg 178:265,1973.PubMedCrossRefGoogle Scholar
  36. 36.
    Roberts AJ, Niarchos AP, Subramanian VA, Abel RM, Hoover EL, McCabe JC, Case DB, Laragh JH, Gay WA Jr: Hypertension following coronary artery bypass graft surgery. Comparison of hemodynamic responses to nitroprusside, phentolamine, and converting enzyme inhibitor. Circulation 58(Suppl I):I–43,1977.Google Scholar
  37. 37.
    Salzman EW, Weinstein MJ, Weintraub RM, Ware JA, Thurer RL, Robertson L, Donovan A, Gaffney T, Bertele V, Troll J, Smith M, Chute, LE: Treatment with desmopressin acetate to reduce blood loss after cardiac surgery: a double-blind randomized trial. N Engl J Med 314:1402,1986.PubMedCrossRefGoogle Scholar
  38. 38.
    Simpkin P, Brown AH, Ersoz A, Braimbridge MV: Chronic left heart tamponade. J Thorac Cardiovasc Surg 65:531,1973.PubMedGoogle Scholar
  39. 39.
    Slaughter L, Morris JE, Starr A: Prosthetic valvular endocarditis, a 12 year review. Circulation 47:1319,1973.PubMedGoogle Scholar
  40. 40.
    Stinson EB, Holloway EL, Derby G, Oyer PE, Hollingsworth J, Griepp RB, Harrison DC: Comparative hemodynamic responses to chlorpromazine, nitroprusside, nitroglycerin, and trimethaphan immediately after open-heart operations. Circulation 51(Suppl I):I–26,1975.Google Scholar
  41. 41.
    Suter PM, Fairley HB, Isenberg MD: Optimum end expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 292:284,1975.PubMedCrossRefGoogle Scholar
  42. 42.
    Swan HJC, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D: Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 283:447,1970.PubMedCrossRefGoogle Scholar
  43. 43.
    Thurer RJ, Bognolo D, Vargas A, Isch JH, Kaiser G A: The management of mediastinal infection following cardiac surgery: an experience utilizing continuous irrigation with povidone-iodine. J Thorac Cardiovasc Surg 68:962,1974.PubMedGoogle Scholar
  44. 44.
    Vander Salm TJ, Ansell JE, Okike ON, Marsicano TH, Lew R, Stephenson WP, Rooney K: The role of epsilon-aminocaproic acid in reducing bleeding after cardiac operation: a double-blind randomized study. J Thorac Cardiovasc Surg 95: 538,1988.Google Scholar
  45. 45.
    Waldo AL, MacLean WAH, Cooper TB, Kouchoukos NT, Karp RB: Use of temporarily placed epicardial atrial wire electrodes for the diagnosis and treatment of cardiac arrhythmias following open-heart surgery. J Thorac Cardiovasc Surg 76: 500,1978.PubMedGoogle Scholar
  46. 46.
    Wareing TH, Davila-Roman VG, Barzilai B, Murphy SF, Kouchoukos NT: Management of the severely atherosclerotic ascending aorta during cardiac operations. J Thorac Cardiovasc Surg 103:453,1992.PubMedGoogle Scholar
  47. 47.
    Woodman RC, Harker LA: Bleeding complications associated with cardiopulmonary bypass. Blood 76:1680,1990.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 1995

Authors and Affiliations

  • Bradley J. Harlan
    • 1
    • 2
    • 3
  • Albert Starr
    • 3
    • 4
    • 5
  • Fredic M. Harwin
    • 6
  • Alain Carpentier
    • 7
  1. 1.Section of Thoracic and Cardiovascular SurgerySutter Memorial HospitalSacramentoUSA
  2. 2.Davis Medical SchoolUniversity of CaliforniaSacramentoUSA
  3. 3.Oregon Health Sciences UniversityPortlandUSA
  4. 4.Heart Institute at St. Vincent HospitalPortlandUSA
  5. 5.Starr-Wood Cardiac Group, P.C.PortlandUSA
  6. 6.Harwin StudiosPortlandUSA
  7. 7.Hôpital BroussaisUniversity of ParisParisFrance

Personalised recommendations