Manual of Perioperative Care in Adult Cardiac Surgery
Robert M. Bojar
Format: PDF / Kindle (mobi) / ePub
The fifth edition of Bojar's Manual of Perioperative Care in Adult Cardiac Surgery remains the gold standard for management of adult patients undergoing cardiac surgery.
The easily referenced outline format allows health practitioners of all levels to understand and apply basic concepts to patient care--perfect for cardiothoracic and general surgery residents, physician assistants, nurse practitioners, cardiologists, medical students, and critical care nurses involved in the care of both routine and complex cardiac surgery patients.
This comprehensive guide features:
- Detailed presentation addressing all aspects of perioperative care for adult cardiac surgery patients
- Outline format allowing quick access to information
- Chronological approach to patient care starting with diagnostic tests then covering preoperative, intraoperative, and postoperative care issues
- Additional chapters discuss bleeding, the respiratory, cardiac, and renal subsystems as well as aspects of care specific to recovery on the postoperative floor
- Updated references, information on new drug indications and new evidence to support various treatment/management options.
Practical and accessible, this new edition of Manual of Perioperative Care in Adult Cardiac Surgery is the essential reference guide to cardiac surgical patient care.
in flow rates. F. Cerebral oximetry, usually using the Somanetics INVOS monitoring system, is an essential element of intraoperative care. It uses near-infrared technology to assess regional cerebral oxygen saturations (rSO2) from bifrontal sensing pads placed on the patient’s forehead (Figure 4.10). A reduction in rSO2 greater than 20% may be associated with adverse neurologic outcomes and should be treated. Prior to bypass, steps to increase the systemic pressure or the PCO2 will improve
preventing AF. ii. Steroids may reduce inflammation and the risk of AF, but commonly cause hyperglycemia and may increase the risk of infection. Study protocols include use of hydrocortisone 100 mg prior to surgery followed by 100 mg q8h × 3 days295 or methylprednisolone 1 g before surgery with additional doses of dexamethasone 4 mg q6h × 24 hours296 iii. Statins at high dose (atorvastatin 40 mg)297,298 iv. ACE inhibitors266 v. Ascorbic acid (vitamin C) given with β-blockers (2 g before
Low-dose epinephrine occasionally causes a metabolic acidosis out of proportion to its α effects when the cardiac output is satisfactory. This may reflect a metabolic type B lactic acidosis (not associated with tissue hypoxia) caused by metabolic factors that increase lactic acid production, such as hyperglycemia and lipolysis.204 3. Intra-abdominal catastrophes, such as mesenteric ischemia from a low-flow state, should always be considered when progressive metabolic acidosis occurs. 4. Sepsis
surgery: factors influencing perioperative outcome and long-term results. Eur Heart J 2006;27:49–56. 102. Timaran CH, Rosero EB, Smith ST, Valentine RJ, Modrall JG, Clagett GP. Trends and outcomes of concurrent carotid revascularization and coronary bypass. J Vasc Surg 2008;48:355–60. 103. Versaci F, Reimers B, Del Giudice C, et al. Simultaneous hybrid revascularization by carotid stenting and coronary artery bypass grafting: the SHARP study. JACC Cardiovasc Interv 2009;2:393–401. 104. Chu D,
Although steroids administered before CPB reduce the generation of inflammatory markers, evidence of any clinical benefit is weak.78 Use of high doses of methylprednisolone (30 mg/kg) has been associated with hyperglycemia and metabolic acidosis.78 Dexamethasone 1 mg/kg has been associated with hyperglycemia, transient subclinical organ system damage, as well as more pronounced pulmonary dysfunction.79 Other studies have shown little clinical benefit other than an improvement in emetic symptoms