Anesthetic Management of Myocardial Revascularization
KEY POINTS 1. The total annual cost of cardiovascular disease in the U.S. is close to 400 billion representing 17% of the total health care costs due to major illness….
Anesthetic Management of Cardiac Transplantation
KEY POINTS 1. Nonischemic cardiomyopathy (53%) is the most common pretransplant diagnosis worldwide. 2. Nearly 70% of recipients in the United States require some form of life support prior to…
Alternative Approaches to Cardiac Surgery with and without Cardiopulmonary Bypass
KEY POINTS 1. Off-pump coronary artery bypass grafting (OPCAB) challenges the anesthesiologist and surgeon to maintain hemodynamic stability while delicate coronary arterial anastomoses are performed on a beating heart. 2….
Postoperative Care of the Cardiac Surgical Patient
KEY POINTS 1. Transport from the operating room (OR) to the intensive care unit (ICU) is a critical period for patient monitoring or vigilance. Emergency drugs and airway equipment should…
Coagulation Management During and After Cardiopulmonary Bypass
KEY POINTS 1. Previous concepts of independent intrinsic and extrinsic plasma coagulation pathways, a cell-free final common pathway, and platelet clotting have given way to an integrated concept of cell-based…
Blood Transfusion
KEY POINTS 1. Both anemia and transfusion carry significant risks. Balancing these risks is the key to appropriate blood transfusion decisions. 2. Despite published guidelines about transfusion, clinical transfusion practice…
Cardiovascular Physiology: A Primer
KEY POINTS 1. The heart has a fibrous skeleton that provides an insertion site at each valvular ring. This fibrous structure also connects cardiac myocytes so that “stretch” or preload…
Anesthetic Management in the Precardiopulmonary Bypass Period
KEY POINTS 1. The incidence of ischemia during this period has been reported to be 7% to 56%. 2. The Society of Thoracic Surgeons recommends a cephalosporin as the primary…
Anesthetic Management during Cardiopulmonary Bypass
KEY POINTS 1. Prior to cannulation for cardiopulmonary bypass (CPB), the anesthesiologist must assure that adequate heparin-induced anticoagulation has been achieved, which is typically diagnosed as an activated clotting time…
The Postcardiopulmonary Bypass Period: Weaning to ICU Transport
KEY POINTS 1. Core temperature (nasopharyngeal or tympanic membrane) should be greater than 36°C before terminating cardiopulmonary bypass (CPB). However, the nasopharyngeal temperature should not exceed 37°C, as this will…
