Cardiac anaesthesia

2021 ◽  
pp. 507-528
Author(s):  
Kelly Byrne ◽  
Kate Goldstone ◽  
Peter Simmons
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Surgery ◽  
Artery Bypass ◽  
Aortic Surgery ◽  
Transoesophageal Echocardiography ◽  
Anaesthetic Management ◽  
Bypass Grafting ◽  
Intraaortic Balloon ◽  
Cardiac Anaesthesia ◽  
Risk Scoring

This chapter discusses the anaesthetic management of cardiac surgery. It begins with preoperative considerations, risk scoring for cardiac surgery, transoesophageal echocardiography and cardiopulmonary bypass (CPB). Surgical procedures covered include coronary artery bypass grafting (CABG) (including emergency and redo CABG); valve replacements and thoracic aortic surgery. Intraaortic balloon pumps and pulmonary hypertension are also covered.

Cardiac surgery

2018 ◽  
Author(s):  
Rhys Evans
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Supply And Demand ◽  
Aortic Surgery ◽  
Anaesthetic Management ◽  
Transcatheter Aortic Valve ◽  
Risk Scoring ◽  
Valve Implantation

This chapter discusses the anaesthetic management of cardiac surgery. It begins with a description of myocardial oxygen supply and demand, risk scoring for cardiac surgery, and cardiopulmonary bypass. Surgical procedures covered include coronary artery bypass grafting (CABG) (including emergency and redo CABG), aortic valve replacement (including transcatheter aortic valve implantation), mitral valve replacement, thoracic aortic surgery, pulmonary thromboembolectomy, cardioversion, and implantation of a cardioverter-defibrillator.

Cardiac surgery

2016 ◽  
Author(s):  
Rhys Evans
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Supply And Demand ◽  
Aortic Surgery ◽  
Anaesthetic Management ◽  
Transcatheter Aortic Valve ◽  
Risk Scoring ◽  
Valve Implantation

This chapter discusses the anaesthetic management of cardiac surgery. It begins with a description of myocardial oxygen supply and demand, risk scoring for cardiac surgery, and cardiopulmonary bypass. Surgical procedures covered include coronary artery bypass grafting (CABG) (including emergency and redo CABG), aortic valve replacement (including transcatheter aortic valve implantation), mitral valve replacement, thoracic aortic surgery, pulmonary thromboembolectomy, cardioversion, and implantation of a cardioverter-defibrillator.

scholarly journals Postoperative Delirium in Patients with Chronic Obstructive Pulmonary Disease after Coronary Artery Bypass Grafting

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 342
Author(s):  
Aleksandra Szylińska ◽  
Iwona Rotter ◽  
Mariusz Listewnik ◽  
Kacper Lechowicz ◽  
Mirosław Brykczyński ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cardiac Surgery ◽  
Pulmonary Disease ◽  
Postoperative Delirium ◽  
Artery Bypass ◽  
Chronic Obstructive ◽  
Bypass Grafting ◽  
Obstructive Pulmonary Disease ◽  
Probability Of Survival ◽  
Copd Patients

Background and Objectives: The incidence of postoperative delirium (POD) in patients with chronic obstructive pulmonary disease (COPD) is unclear. It seems that postoperative respiratory problems that may occur in COPD patients, including prolonged mechanical ventilation or respiratory-tract infections, may contribute to the development of delirium. The aim of the study was to identify a relationship between COPD and the occurrence of delirium after cardiac surgery and the impact of these combined disorders on postoperative mortality. Materials and Methods: We performed an analysis of data collected from 4151 patients undergoing isolated coronary artery bypass grafting (CABG) in a tertiary cardiac-surgery center between 2012 and 2018. We included patients with a clinical diagnosis of COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The primary endpoint was postoperative delirium; Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) was used for delirium assessment. Results: Final analysis included 283 patients with COPD, out of which 65 (22.97%) were diagnosed with POD. Delirious COPD patients had longer intubation time (p = 0.007), more often required reintubation (p = 0.019), had significantly higher levels of C-reactive protein (CRP) three days after surgery (p = 0.009) and were more often diagnosed with pneumonia (p < 0.001). The CRP rise on day three correlated positively with the occurrence of postoperative pneumonia (r = 0.335, p = 0.005). The probability of survival after CABG was significantly lower in COPD patients with delirium (p < 0.001). Conclusions: The results of this study confirmed the relationship between chronic obstructive pulmonary disease and the incidence of delirium after cardiac surgery. The probability of survival in COPD patients undergoing CABG who developed postoperative delirium was significantly decreased.

Recombinant Human Transgenic Antithrombin in Cardiac Surgery

2002 ◽  
Vol 96 (5) ◽  
pp. 1095-1102 ◽  
Author(s):  
Jerrold H. Levy ◽  
George J. Despotis ◽  
Fania Szlam ◽  
Peter Olson ◽  
David Meeker ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Antithrombin Iii ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Fibrin Monomer ◽  
D Dimer

Background Acquired antithrombin III (AT) deficiency may render heparin less effective during cardiac surgery and cardiopulmonary bypass (CPB). The authors examined the pharmacodynamics and optimal dose of recombinant human AT (rh-AT) needed to maintain normal AT activity during CPB, optimize the anticoagulant response to heparin, and attenuate excessive activation of the hemostatic system in patients undergoing coronary artery bypass grafting. Methods Thirty-six patients scheduled to undergo elective primary coronary artery bypass grafting and who had received heparin for 12 h or more before surgery were enrolled in the study. Ten cohorts of three patients each received rh-AT in doses of 10, 25, 50, 75, 100, 125, 175, or 200 U/kg, a cohort of six patients received 150 U/kg of rh-AT, and a control group of six patients received placebo. Results Antithrombin III activity exceeded 600 U/dl before CPB at the highest dose (200 U/kg). Doses of 75 U/kg rh-AT normalized AT activity to 100 U/dl during CPB. Activated clotting times during CPB were significantly (P &lt; 0.0001) greater in patients who received rh-AT (844 +/- 191 s) compared with placebo patients (531 +/- 180 s). Significant (P = 0.001) inverse relations were observed between rh-AT dose and both fibrin monomer (r = -0.51) and D-dimer (r = -0.51) concentrations. No appreciable adverse events were observed with any rh-AT doses used in the study. Conclusions Supplementation of native AT with transgenically produced protein (rh-AT) in cardiac surgical patients was well tolerated and resulted in higher activated clotting times during CPB and decreased levels of fibrin monomer and D-dimer.

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