Manual of Perioperative Care in Adult Cardiac Surgery

Preface ix

Acknowledgments xi

1. Synopsis of Adult Cardiac Surgical Disease 1

2. Diagnostic Techniques in Cardiac Surgery 85

3. General Preoperative Considerations and Preparation of the Patient for Surgery 129

4. Cardiac Anesthesia 173

5. Cardiopulmonary Bypass  227

6. Myocardial Protection 263

7. Admission to the ICU and Monitoring Techniques 279

8. Early Postoperative Care 301

9. Mediastinal Bleeding 345

10. Respiratory Management 383

11. Cardiovascular Management 437

12. Fluid Management, Renal, Metabolic, and Endocrine Problems 581

13. Post-ICU Care and Other Complications 641

Appendices 727

Appendix 1A American College of Cardiology Classes of Recommendation and Levels of Evidence 729

Appendix 1B New York Heart Association Functional Classification 729

Appendix 2 Typical Preoperative Order Sheet 730

Appendix 3 Typical Orders for Admission to the ICU 731

Appendix 4 Typical Transfer Orders from the ICU 734

Appendix 5 Typical ICU Flowsheet 737

Appendix 6 Hyperglycemia Protocol for Cardiac Surgery Patients 738

Appendix 7 Heparinization Protocol for Cardiac Surgery Patients 739

Appendix 8 Protocol for Initiating Warfarin 740

Appendix 9 INR Reversal Protocol 741

Appendix 10 Drug, Food, and Dietary Supplement Interactions with Warfarin 742

Appendix 11 Doses of Parenteral Medications Commonly Used in the ICU and Their Modification in Renal Failure 743

Appendix 12 Doses of Nonparenteral Drugs Commonly Used

After Heart Surgery and Their Modifications in Renal Failure 747

Appendix 13 Definitions from the STS Data Specifications (Version 2.7 2011) 753

Appendix 14 Body Surface Area Nomogram 756

Appendix 15 Body Mass Index Chart 757

Appendix 16 Technique of Thoracentesis 758

Appendix 17 Technique for Tube Thoracostomy 759

Appendix 18 Technique of Insertion of Percutaneous Tracheostomy Tube 761

Index 765