Handbook of Patient Care in Cardiac Surgery 7th Edition by John H Lemmer Jr, MD Gus J Vlahakes MD – Ebook PDF Instant Download/DeliveryISBN: 1451104141, 9781451104141
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ISBN-10 : 1451104141
ISBN-13 : 9781451104141
Author: John H Lemmer Jr, MD Gus J Vlahakes MD
The thoroughly updated Seventh Edition of this popular and widely used handbook presents the most current protocols and recommendations for care of patients undergoing cardiac surgery. This edition reflects current ACLS guidelines and the latest developments in cardiac surgery. The transplantation chapter has been entirely rewritten by a new author. Experts from leading hospitals offer detailed, practical guidelines on preoperative evaluation and preparation, intraoperative management, and postoperative care for all current cardiac surgical procedures. Perspectives valuable for cardiac surgeons, cardiac nurses, and anesthesiologists are included throughout. Coverage includes a chapter on infants and children. Appendices list drug dosages for adults and for infants and children.
Handbook of Patient Care in Cardiac Surgery 7th Table of contents:
1: Preoperative Evaluation and Management
MEDICAL HISTORY
TABLE 1.1: Canadian Cardiovascular Society Functional Classification of Angina Pectoris
TABLE 1.2: New York Heart Association Functional Classification for Heart Failure
TABLE 1.3: Risk Factors for Coronary Heart Disease
MEDICATIONS
TABLE 1.4: Commonly Used Herbal Supplements
PHYSICAL EXAMINATION
LABORATORY TESTING
TABLE 1.5: Preoperative Testing
DIAGNOSTIC STUDIES
PRESURGERY VISIT
PREOPERATIVE PREDICTION OF POSTOPERATIVE COMPLICATIONS
TABLE 1.6: Preoperative Variables Commonly Used to Assess Surgical Risk
SPECIAL PREOPERATIVE PROBLEMS
Depressed Left Ventricular Function
Left Main Coronary Artery Disease
Recent Acute Myocardial Infarction
Critical Aortic Valve Stenosis
Acute Valve Regurgitation and Malfunctioning Prosthetic Valves
The Patient with Chronic Kidney Disease
Pregnancy
SKIN PREPARATION AND ANTIBIOTIC PROPHYLAXIS
References
2: Operative Management
BASIC MONITORING
FIGURE 2.1
FIGURE 2.2
FIGURE 2.3
FIGURE 2.4
FIGURE 2.5
OTHER MONITORING TECHNIQUES
NEUROLOGIC MONITORING DURING CARDIAC SURGERY
PACING AND ARRHYTHMIAS
ANESTHESIA
CONDUCT OF THE OPERATION
FIGURE 2.6
FIGURE 2.7
FIGURE 2.8
ANTICOAGULATION FOR CARDIOPULMONARY BYPASS
Heparin
Protamine
Heparin Resistance
Heparin-Induced Thrombocytopenia
TECHNIQUES OF EXTRACORPOREAL CIRCULATION (PERFUSION)
FIGURE 2.9
FIGURE 2.10
FIGURE 2.11
FIGURE 2.12
Myocardial Protection
Hypothermia
Cardioplegia
Profound Hypothermia and Circulatory Arrest
Separation from Cardiopulmonary Bypass
Rhythm
FIGURE 2.13
Weaning from Bypass
Right Heart Failure
Decannulation
CORONARY BYPASS SURGERY WITHOUT CARDIOPULMONARY BYPASS
Graft Patency Following Coronary Bypass Surgery
Pericardial Closure
Closure of the Chest
FIGURE 2.14
Special Problems in Chest Closure
TRANSPORT OF THE PATIENT
References
3: Postoperative Management
FIGURE 3.1
MANAGEMENT OF THE HEMODYNAMIC STATE
Evaluation and Monitoring of Cardiovascular Function
TABLE 3.1: Hemodynamic Parameters
Management of the Cardiac Output
Management of the Blood Pressure
Postoperative Hypotension
Postoperative Hypertension
TABLE 3.2: Drugs for the Acute Treatment of Early Postoperative Hypertension (Adult Intravenous Doses)
PULMONARY CARE
FIGURE 3.2
Mechanical Ventilators
Use of Arterial Blood Gas Determination
Weaning Ventilator Support
TABLE 3.3: Patient Characteristics for Early Extubation
TABLE 3.4: Criteria for Extubation
FIGURE 3.3
FLUIDS AND ELECTROLYTES
Postoperative Fluid Management
Potassium
Sodium
Calcium
Magnesium
ACID–BASE BALANCE
TABLE 3.5: Acid–Base Disturbances
Acidosis
Alkalosis
USE OF BLOOD PRODUCTS IN THE PERIOPERATIVE PERIOD
The Risks of Blood Transfusion
TABLE 3.6: Risks of Blood Transfusion
Indications for Transfusion
TABLE 3.7: Blood Product Transfusion Guidelines in Postoperative Cardiac Surgery Patients
Reducing Postoperative Bleeding and Transfusions
Predicting the Need for Blood Product Transfusions
TABLE 3.8: Risk Factors Associated with Bleeding and Transfusion
Preoperative Measures to Reduce Bleeding and Transfusions
Intraoperative Measures to Reduce Bleeding and Transfusions
Drugs to Reduce Bleeding and Transfusions
Postoperative Reinfusion of Shed Mediastinal Blood
PAIN CONTROL
TABLE 3.9: Commonly Used Pain Medications
DIURETIC THERAPY
DIABETES MANAGEMENT
NUTRITIONAL SUPPORT
CARE OF THE RADIAL ARTERY HARVEST SITE
References
4: Postoperative Complications Involving the Heart and Lungs
LOW CARDIAC OUTPUT (CARDIOGENIC SHOCK)
Management of Low Cardiac Output
FIGURE 4.1
Inotropic Drug Treatment of Low Cardiac Output
TABLE 4.1: Effects of Pharmacologic Agents Used to Treat Hypotension and Low Cardiac Output
Vasoactive Drugs in the Management of Low Cardiac Output
Low Cardiac Output Due to Right Ventricular Failure
Low Cardiac Output Due to Diastolic Dysfunction
PULMONARY HYPERTENSION
CARDIAC ARREST
POSTOPERATIVE CARDIAC ARRHYTHMIAS
TABLE 4.2: Management Strategies for Postoperative Arrhythmias
TABLE 4.3: Commonly Used Parenteral Drugs for Treating Postoperative Arrhythmias
Postoperative Bradyarrhythmia
Management of Temporary Cardiac Pacing Systems
Postoperative Tachyarrhythmias
Wide QRS-Complex Tachycardia
Narrow QRS-Complex Tachycardia
Sinus Tachycardia and Re-entry Supraventricular Tachycardia
Atrial Fibrillation and Flutter
FIGURE 4.2
FIGURE 4.3
Prevention of Postoperative Atrial Fibrillation.
Treatment of Atrial Fibrillation.
TABLE 4.4: Amiodarone Administration to Treat Postoperative Atrial Fibrillation (Adult Doses)
Atrial Flutter.
Persistent Postoperative Atrial Arrhythmias
Junctional Ectopic Tachycardia
Ventricular Tachyarrhythmias
PERIOPERATIVE MYOCARDIAL ISCHEMIA AND INFARCTION
Perioperative Infarction
TABLE 4.5: Electrocardiographic (ECG) Identification of Acute Myocardial Infarction (MI) Location
Coronary Artery Spasm
PULMONARY COMPLICATIONS
Atelectasis
Bronchospasm
Phrenic Nerve Injury
Prolonged Respiratory Insufficiency
Acute Respiratory Distress Syndrome
Pneumothorax
FIGURE 4.4
Pleural Effusions
References
5: Postoperative Complications Involving Other Organ Systems
BLEEDING AFTER HEART SURGERY
Platelets and Bleeding in Cardiac Surgery Patients
Thrombocytopenia
Platelet Dysfunction
Drugs that Cause Platelet Dysfunction
TABLE 5.1: Commonly Used Platelet-Inhibiting Drugs
Aspirin.
Clopidogrel.
Platelet Glycoprotein IIb/IIIa Receptor Inhibitors.
Clotting Factors and Fibrinogen
Heparin
Fibrinolysis
Disseminated Intravascular Coagulation
MANAGEMENT OF THE BLEEDING PATIENT
FIGURE 5.1
Cardiac Tamponade
Intractable Hemorrhage
RENAL FAILURE
FIGURE 5.2
INFECTIOUS COMPLICATIONS
Wound Infections and Mediastinitis
TABLE 5.2: Infection Risk Scores for Major Infection After Coronary Artery Bypass Graft
TABLE 5.3: Estimated Probability of Infection by Risk Score Category
Pneumonia
Catheter Sepsis
GASTROINTESTINAL COMPLICATIONS
Intestinal Ileus
Gastrointestinal Tract Bleeding
Intestinal Ischemia
Acute Cholecystitis
Acute Pancreatitis
Acute Hepatic Failure
Nausea, Dysphagia, Diarrhea, and Hiccups
NEUROLOGIC COMPLICATIONS
Stroke
FIGURE 5.3
Delirium
Postoperative Cognitive Decline
PERIPHERAL NERVE INJURY
COMPLICATIONS OF SAPHENOUS VEIN HARVESTING
COMPLICATIONS RELATED TO THE USE OF THE RADIAL ARTERY
COMPLICATIONS RELATED TO INTERNAL MAMMARY ARTERY MOBILIZATION
DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM
References
6: Late Postoperative Management
CARDIAC REHABILITATION
IMPROVING GRAFT PATENCY AFTER CABG
COMPLICATIONS OF PROSTHETIC VALVES
Infection
Deterioration of Tissue Prosthetic Valves
Malfunction of Mechanical Valves
Paravalvular Leaks
Thromboembolism and Anticoagulation
TABLE 6.1: Antithrombotic Therapy—Prosthetic Heart Valvesa
TABLE 6.2: Drug Interactions with Warfarin
LONG-TERM ISSUES IN PATIENTS RECEIVING WARFARIN
PERICARDITIS AND DELAYED PERICARDIAL TAMPONADE
References
7: Management of Infants and Children
OVERVIEW
Brief Review of Common Lesions
Septal Defects
Atrioventricular Canal
Tetralogy of Fallot
Pulmonary Atresia with Ventricular Septal Defect
Pulmonary Atresia with Intact Ventricular Septum
Transposition of the Great Arteries
Coarctation of the Aorta and Interrupted Aortic Arch
Patent Ductus Arteriosus
Aortopulmonary Window
Truncus Arteriosus
Total Anomalous Pulmonary Venous Connection
Aortic Stenosis
Univentricular Heart
Tricuspid Atresia
Hypoplastic Left Heart Syndrome
PREOPERATIVE PREPARATION
Ductus-Dependent Lesions
TABLE 7.1: Lesions Palliated by PGE1 Infusion
OPERATIVE CONSIDERATIONS
Monitoring Lines
FIGURE 7.1
POSTOPERATIVE CARE
Assessment of Cardiovascular Status
Physical Examination
Mixed Venous Saturation
Treatment of Low Cardiac Output
Tamponade Physiology
Residual Lesions
Pulmonary Management
TABLE 7.2: Endotracheal Tube (ETT) Size and Intubation Guidelines
TABLE 7.3: Potential Complications of Ventilating Neonates with High Concentrations of Oxygen
Pulmonary Hypertension
Parallel Circulations and Control of the Pulmonary Circulation
FIGURE 7.2
TABLE 7.4: Control of Pulmonary Blood Flow
Cardiac Rhythm Management
Fluids, Electrolytes, and Nutrition
Routine Fluid and Electrolyte Management
Nutritional Management
Glucose
Calcium
Potassium
Special Problems
Coagulation Disorders and Transfusion
Paradoxical Hypertension After Coarctation Repair
Temperature Regulation
Effects of Profound Hypothermia and Circulatory Arrest
Seizure Activity
Renal Failure
Sepsis
Postoperative Investigations
Postoperative Echocardiography
References
8: Mechanical Cardiac Support and Transplantation
TABLE 8.1: Definition of Ventricular Failure
INTRA-AORTIC BALLOON COUNTERPULSATION
Insertion of Intra-Aortic Balloon Pump
FIGURE 8.1
Indications for Use of the Intra-Aortic Balloon Pump
FIGURE 8.2
Complications of Intra-Aortic Balloon Pump
VENTRICULAR ASSIST DEVICES
Ventricular Assist Device Classes and Systems
TABLE 8.2: Ventricular Assist Devices
Devices for Short-Term Support
Percutaneous Ventricular Assist Devices
Devices for Long-Term Support
Pulsatile Long-Term Ventricular Assist Devices
Thoratec.
FIGURE 8.3
HeartMate I XVE.
Continuous Flow Devices for Long-Term Support
Ventricular Assist Device Physiology and Right Ventricular Function
Salvage VAD Use: Cardiogenic Shock, Postcardiotomy Cardiogenic Shock
Patient Selection.
Device Selection and Implantation Technique.
FIGURE 8.4
Postoperative Care
Management Issues with Ventricular Assist Devices.
Antibiotic Prophylaxis.
Weaning from Mechanical Circulatory Support.
Advanced Heart Failure: Bridge to Recovery, Bridge to Cardiac Transplant, Destination Therapy
Bridge to Recovery
Indications for Ventricular Assist Device as Bridge to Transplant
Indications for Ventricular Assist Device Insertion as Bridge to Transplant
Management of the Patient with an Elevated Pulmonary Vascular Resistance
Patient Preparation
Ventricular Assist Device Selection
Operative Management
Postoperative Care
Anticoagulation for the Ventricular Assist Device Patient
Ventricular Assist Device Explantation and Cardiac Transplantation
CARDIAC TRANSPLANTATION
Cardiac Recipient Selection
TABLE 8.3: Cardiac Transplant Recipient Selection and Exclusion Criteria
Pulmonary Hypertension and Pulmonary Vascular Resistance
TABLE 8.4: UNOS Cardiac Transplant Recipient Status
Cardiac Donation
Cardiac Donor Selection Criteria
TABLE 8.5: Cardiac Donor Selection and Exclusion Criteria
Donor Management
Donor Cardiectomy
FIGURE 8.5
Cardiac Recipient Management
Cardiac Recipient Preparation
Timing of the Donor and Recipient Operations
Recipient Operative Management
FIGURE 8.6
FIGURE 8.7
FIGURE 8.8
Right Ventricular Failure Posttransplant.
Postoperative Management
Hemodynamics
Infection
Immunosuppression
Other Management Issues
Long-Term Problems
Rejection
TABLE 8.6: International Society for Heart & Lung Transplantation Standardized Cardiac Biopsy Grading Scale
Infection
Malignancy
Allograft Coronary Artery Disease
References
Back Matter
SUBJECT INDEX
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