Postoperative Critical Care for Cardiac Surgical Patients

Postoperative Critical Care for Cardiac Surgical Patients

Ali Dabbagh Fardad Esmailian Sary F. Aranki Editors Postoperative Critical Care for Cardiac Surgical Patients

Editors Ali Dabbagh, MD Department of Anesthesiology and Anesthesiology Research Center Faculty of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran Sary F. Aranki, MD Divisions of Cardiac Surgery Brigham and Women s Hospital Boston, MA USA Fardad Esmailian Heart Transplant and Mechanical Circulatory Support Cedars-Sinai Heart Institute Los Angeles, CA USA ISBN 978-3-642-40417-7 ISBN 978-3-642-40418-4 (ebook) DOI 10.1007/978-3-642-40418-4 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2013955229 Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

To my wife Samira and to my Parents Ali Dabbagh To my family: Yvonne, Gabriel and Aaron and to my parents Fardad Esmailian To Nadia, Alex, Heather and Abla Sary F. Aranki

Foreword The Handbook of Postoperative Critical Care for Cardiac Surgeries is a superb amalgamation of a wide variety of clinical expertise in the perioperative and postoperative care of cardiac surgical patients edited by three very fine academicians from three outstanding medical centers and who are in the position of being able to judge the best perioperative and postoperative cardiac surgical care. The three editors have a wide variety of cardiac surgical interest. Dr. Dabbagh is a cardiac anesthesiologist, who is intimately involved in the intraoperative and postoperative care of cardiac surgery patients; Dr. Esmailian is an expert in the care of patients receiving cardiac assist devices and cardiac transplantation, which are some of the most challenging postoperative patients; and Dr. Aranki is an extremely talented surgeon in all aspects of cardiac surgery, especially coronary artery bypass grafting and valve repair and replacement. This book brings the entire spectrum of cardiac surgical perioperative treatment and postoperative care under one cover. Postoperative critical care in cardiac surgery is extremely important and I believe this book has the potential to be the gold standard in postoperative care for cardiac surgical patients. The key to good surgical results is the combination of an excellent operation and meticulous perioperative and postoperative care, the essence of this book. The authors are to be complimented for providing up-to-date, accurate, and intellectual contributions for this most important area of cardiac surgery. This book is an excellent effort in advancing the art and science of perioperative and postoperative surgical care. Lawrence H. Cohn, MD Brigham and Women s Hospital Harvard Medical School, Boston, MA, USA vii

Preface Cardiac surgery is a process, not an event. Due to the prevalence of cardiac diseases and conditions within society, cardiac surgeries now rank among the most common of all surgical procedures. But they are also the most challenging and complicated, all of which imposes a burden of instructive issues upon students and faculty alike. The following is a handbook encompassing the entire period of postoperative cardiac surgical care, including the basic physiologic and pharmacologic knowledge to clinical aspects of clinical care in different major body organs. This book stresses on this point that during postoperative period, the patient commences upon a highly complex set of postoperative challenges and will often require lifelong monitoring to ensure that the management of all potential morbidities has been achieved. Surgery is not, therefore, an end, but rather a beginning. In the often long-term postoperative era, a patient embarks upon a new set of needs for recovery and lifelong follow-up. Towards this end of perioperative care, it is most crucial not to view the surgery and anesthesia as the climax of a patient s experience, but rather as a bridge between a former and a new life for the patient. While postoperative care plays a crucial role in determining the clinical result for the patient, the success of postoperative care is also directly affected by the quality of the pre- and intraoperative experiences. The chapters of this book, therefore, also survey these seminal periods for the patient, with particular attention given to cardiopulmonary bypass. Other chapters assume an organ-oriented perspective in addressing critical care. This broad, intersystemic approach creates a holistic view of the cardiac domain not only in its functions within itself but also within the entire body, enabling this to become a reliable guidebook for cardiac intensive care. This book can then be used by cardiac surgeons, cardiac anesthesiologists, intensivists, and cardiac intensive care nurses, as well as the students, interns, and residents learning in such environments, in the successful management of the process of cardiac surgery. This book could not have been come to fruition without the very committed and compassionate teamwork of Springer Company, especially Springer-Verlag Berlin Heidelberg. The authors should acknowledge among a long list of people especially to the following people: Dr Ute Heilmann, Meike Stock, Martina Himberger, Dörthe Mennecke-Bühler, Sally Ellyson, Margaret Zuccarini, Megan Hughes, Karthikeyan Gurunathan and Palanisamy Dhanapal. ix

x Preface Also, the author would like to acknowledge the kind assistance of Heather M. Couture, Division of Cardiac Surgery, Brigham and Women s Hospital, Boston, MA, USA and Ann M. Maloney could not be forgotten. We also have to acknowledge the creative, expressive and cultivated drawings of Majid Ghaznavi which are used in Chapters 1, 4, 5, 7, 8, and 12. And finally, we have to acknowledge our families who have inspired us with accompaniment, empathy, sacrifice and endless love in such a way that we could promote this effect. Tehran, Iran Los Angeles, CA, USA Boston, MA, USA Ali Dabbagh, MD Fardad Esmailian Sary F. Aranki, MD

Contents 1 Cardiac Physiology........................................ 1 Ali Dabbagh 2 Cardiovascular Pharmacology............................... 41 Robert Fellin 3 Principles of Pharmacoeconomics............................ 73 Felice Eugenio Agrò, Marialuisa Vennari, and Maria Benedetto 4 Cardiovascular Monitoring.................................. 77 Ali Dabbagh 5 Postoperative Central Nervous System Monitoring.............. 129 Ali Dabbagh 6 Postoperative Bleeding Disorders After Cardiac Surgery......... 161 Sylvia Martin-Stone 7 Cardiovascular Complications and Management After Cardiac Surgery...................................... 197 Mahnoosh Foroughi and Antonio Hernandez Conte 8 Noncardiac Complications After Cardiac Surgery.............. 213 Antonio Hernandez Conte and Mahnoosh Foroughi 9 Postoperative Rhythm Disorders After Adult Cardiac Surgeries.................................... 233 Majid Haghjoo 10 Postoperative CNS Care.................................... 245 Ali Dabbagh 11 Postoperative Pain Management in Cardiac Surgery............ 257 Ali Dabbagh 12 Postoperative Considerations of Cardiopulmonary Bypass in Adult Cardiac Surgery................................... 295 Mahnoosh Foroughi xi

xii Contents 13 Fluid Management and Electrolyte Balance.................... 313 Felice Eugenio Agrò, Marialuisa Vennari, and Maria Benedetto 14 Acid Base Balance and Blood Gas Analysis.................... 385 Felice Eugenio Agrò, Marialuisa Vennari, and Maria Benedetto 15 Risk and Outcome Assessments.............................. 417 Manuel Caceres Index........................................................ 429