medigraphic.com
ISSN 2448-5640 (Print)
Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2023, Number 1

<< Back Next >>

Cir Card Mex 2023; 8 (1)

Postoperative management of the patient undergoing coronary artery bypass grafting

Flores-Figueroa F

Language: English
References: 18
Page: 17-21
PDF size: 168.50 Kb.


ABSTRACT

Postoperative care of the heart begins before surgery with a complete evaluation of the patient so that we can anticipate trans and postoperative complications. Comorbidities can be divided into two types, cardiological ones such as LVEF, pulmonary hypertension, concomitant heart valve diseases, presence of evolving coronary syndrome, etc., and non-cardiological ones such as COPD, diabetes, liver disease, neurological conditions and infections, among others. Some medications must be discontinued prior to surgery such as not applying insulin the night before, and others can be continued, such as antiplatelet agents, beta- blockers, and statins. Management in the Cardiological Intensive Care unit begins beforehand; we must be already prepared and know the type of patient and conditions; therefore, we must have the mechanical ventilator or supplemental oxygen support ready, as the case may be, the drugs and infusion pumps, invasive and non-invasive vital signs monitors as well as special devices such as intraaortic balloon pump, ECMO, etc. The following article shows a broad overview about the postoperative care of the patient undergoing coronary revascularization.


REFERENCES

  1. Julian DG. Treatment of cardiac arrest in acute myocardial ischaemia and infarction.Lancet. 1961;2(7207):840-4. doi: 10.1016/s0140-6736(61)90738-3.

  2. Jacobey JA, Taylor WJ, Smith GT, Gorlin R, Harken DE. A new therapeutic approachto acute coronary occlusion. Surg Forum. 1961;12:225-7.

  3. Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI Guidelinefor Coronary Artery Revascularization: Executive Summary: A Report of theAmerican College of Cardiology/American Heart Association Joint Committeeon Clinical Practice Guidelines. Circulation. 2022;145(3):e4-e17. doi: 10.1161/CIR.0000000000001039.

  4. Bojar RM. Manual of Perioperative Care in Adult Cardiac Surgery, 6th Edition.Publisher: Wiley-Blackwell, Year: 2020. ISBN: 978-1-119-58255-7.

  5. Nakagawa M, Tanaka H, Tsukuma H, Kishi Y. Relationship between the durationof the preoperative smoke-free period and the incidence of postoperative pulmonarycomplications after pulmonary surgery. Chest. 2001;120(3):705-10. doi:10.1378/chest.120.3.705.

  6. Mueller C, Scholer A, Laule-Kilian K, et al. Use of B-type natriuretic peptide in theevaluation and management of acute dyspnea. N Engl J Med. 2004;350(7):647-54.doi: 10.1056/NEJMoa031681.

  7. Halkos ME, Lattouf OM, Puskas JD, et al. Elevated preoperative hemoglobinA1c level is associated with reduced long-term survival after coronary arterybypass surgery. Ann Thorac Surg. 2008;86(5):1431-7. doi: 10.1016/j.athoracsur.2008.06.078.

  8. Alserius T, Anderson RE, Hammar N, Nordqvist T, Ivert T. Elevated glycosylatedhaemoglobin (HbA1c) is a risk marker in coronary artery bypass surgery. ScandCardiovasc J. 2008;42(6):392-8. doi: 10.1080/14017430801942393.

  9. Kim HJ, Shim JK, Youn YN, Song JW, Lee H, Kwak YL. Influence of preoperativehemoglobin A1c on early outcomes in patients with diabetes mellitusundergoing off-pump coronary artery bypass surgery. J Thorac Cardiovasc Surg.2020;159(2):568-576. doi: 10.1016/j.jtcvs.2019.01.086.

  10. Reddy P, Duggar B, Butterworth J. Blood glucose management in the patient undergoingcardiac surgery: A review. World J Cardiol. 2014;6(11):1209-17. doi:10.4330/wjc.v6.i11.1209

  11. Lazar HL, McDonnell M, Chipkin SR, et al; Society of Thoracic Surgeons BloodGlucose Guideline Task Force. The Society of Thoracic Surgeons practice guidelineseries: Blood glucose management during adult cardiac surgery. Ann ThoracSurg. 2009;87(2):663-9. doi: 10.1016/j.athoracsur.2008.11.011.

  12. Jacob KA, Hjortnaes J, Kranenburg G, de Heer F, Kluin J. Mortality after cardiacsurgery in patients with liver cirrhosis classified by the Child-Pugh score. InteractCardiovasc Thorac Surg. 2015;20(4):520-30. doi: 10.1093/icvts/ivu438.

  13. Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Guyton RA, Thourani VH. Impactof preoperative neurologic events on outcomes after coronary artery bypass grafting.Ann Thorac Surg. 2008;86(2):504-10; discussion 510. doi: 10.1016/j.athoracsur.2008.04.011.

  14. Durand DJ, Perler BA, Roseborough GS, et al. Mandatory versus selectivepreoperative carotid screening: a retrospective analysis. Ann Thorac Surg.2004;78(1):159-66; discussion 159-66. doi: 10.1016/j.athoracsur.2004.02.024.

  15. Siminelakis S, Karfis E, Anagnostopoulos C, Toumpoulis I, Katsaraki A, DrossosG. Harvesting radial artery and neurologic complications. J Card Surg.2004;19(6):505-10. doi: 10.1111/j.0886-0440.2004.04090.x.

  16. Denton TA, Trento L, Cohen M, et al. Radial artery harvesting for coronary bypassoperations: neurologic complications and their potential mechanisms. J ThoracCardiovasc Surg. 2001;121(5):951-6. doi: 10.1067/mtc.2001.112833.

  17. Moreno-González A, Martínez-Ramírez L, Flores-Figueroa F, Cueto-Robledo G,Antonio-de la Viña M, Baranda-Tova FM. Cuidados posoperatorios del pacienteno complicado. Arch Cardiol Mex. 2011; 81(Supl. 2): 16-23.

  18. Reynolds L, Beckmann J, Kurz A. Perioperative complications of hypothermia.Best Pract Res Clin Anaesthesiol. 2008;22(4):645-57. doi: 10.1016/j.bpa.2008.07.005.




2020     |     www.medigraphic.com