Patient Care in Cardiac Surgery
for Clinicians Along the Cardiac Surgical Pathway

Suitable for trainee clinicians of various disciplines who find themselves involved in the management of patients undergoing cardiac surgery, this book is also useful for those who are involved in such care in the operating theatre, and elsewhere along the cardiac surgical pathway as an insight to both preoperative and postoperative needs.

Sections cover the following topics: preoperative evaluation, to theatre - preparation for surgery, before cardiopulmonary bypass, all about cardiopulmonary bypass, arresting the heart and myocardial protection, adult surgical procedures, weaning from bypass, clotting, drugs and support after bypass, chest closure, and transfer to postoperative critical care. This book also incorporates a CD-ROM with animations which illustrate some of the more pertinent points of the text.

SECTION ONE: Introductory briefing:
1. Circulatory manipulation
2. Myocardial oxygenation
3. Aortic stenosis versus Aortic regurgitation
4. Mitral stenosis versus mitral regurgitation
SECTION TWO: Preoperative evaluation
1. The patient
2. The operation
3. Cardiac data
4. Surgical scoring systems
5. ECG
6. Brief me about the patient
7. Drugs before surgery
SECTION THREE: To Theatre. Preparation for surgery
1. Anaesthesia
2. In the anaesthetic area
3. Vascular access
4. Other invasive monitoring and access
5. TEE / TOE
SECTION FOUR
Before cardiopulmonary by-pass
1. The working environment
2. Arrival into the operating room
3. Antibiotic prophylaxis
4. ABG and ACT
5. Drugs and infusions
6. During chest opening
7. Harvesting of conduit
8. Cannulation of the heart
SECTION FIVE: all about cardiopulmonary by-pass
1. CPBP. The plumbing
2. Sleep
3. Managing the blood pressure on by-pass
4. The circulation on by-pass
5. Haemodilution and fluid balance
6. The effects of CPBP
the bad things
SECTION SIX: arresting the heart and myocardial protection
1. preamble
2. arresting the heart
3. myocardial protection during induced ischaemia
SECTION SEVEN: adult surgical procedures
1. coronary artery surgery
2. valve procedures
3. aortic valve replacement
4. mitral valve surgery
5. combined valve and CABG
6. re-do surgery
7. complex elective surgery to the aorta
8. emergency surgery
9. complex surgery
SECTION EIGHT: weaning from bypass
1. rewarming phase
2. de-airing the heart
3. re-establishing a cardiac rhythm
4. check bleeding and lungs
5. pre-wean checks
6. how is a patient taken off bypass?
7. after coming off by-pass
SECTION NINE
clotting, drugs and support after by-pass
1. restoring coagulation
2. inotropic support
3. vasoconstrictors
4. glyceryl trinitrate
5. other drugs after by-pass
6. intra-aortic balloon pumping
SECTION TEN: chest closure
1. haemostasis
2. thermostasis
3. circulatory control during chest closure
4. gas exchange, blood chemistry and urine output
SECTION ELEVEN: transfer to post-operative critical care
1. transferring a patient after cardiac surgery
2. what critical care is needed?
3. fast-tracking in cardiac surgery