morning report
TRANSCRIPT
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October 7, 2010
Morning Report
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Complications of Cardiac Surgery
Morbidity and Mortality rates have decreasedBetter techniquesPrevention of infectionsBetter knowledge of complications
Three time periodsImmediate post-opShort-term post-opLong-term post-op
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Cardiac Surgery
Immediate post-opIntubationAnesthetic agentsBlood lossFluid managementLength of time on bypass
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Cardiac SurgeryImmediate post-op
RespiratoryIntubation
Vocal cord damageSecretions
Low cardiac outputTachycardia, decreased UOP, decreased BPFluid vs pump failure
ArrhythmiasAny surgery near the atriaTachycardiaBradycardia
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Cardiac SurgeryImmediate post-op
HTNCoarctation or PDAManaged medically but usually short livedCoarctation
Postcoarctation syndromeo Abd pain, infarction of bowel
ChylothoraxCreamy fluid in chest tubes, high fat content,
negative cultureDamage to thoracic ductModify diet – low fat
Portagen for babiesMay reside on own or require chest tubes or surgery
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Cardiac Surgery
Short-term post-op
Postpericardiotomy SyndromeFebrile illness7-10 post op dayPericardial and/or pleural reactionChildren>InfantsExtensive proceduresMost cases are mild
May only be found on post op echo as an effusion
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Cardiac SurgeryShort-term post-op
Postpericardiotomy SyndromeSymptoms
Fever into second post-op weeko Or may return in 2nd or 3rd week
Anterior precordial chest paino Increases on deep inspirationo Increases when supine
Intermittent friction rub
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Cardiac SurgeryShort-term post-op
Postpericardiotomy SyndromeLab findings
Increased WBCo Left shift
Increased ESRECG
Flattened or inverted T wavesEcho
Pericardial effustion
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Cardiac SurgeryShort-term post-op
Postpericardiotomy SyndromeUsually self limitedPersistence of effusion is concerning
Tamponadeo Muffled heart sounds, pulsus paradoxus, JVD
Antiinflammatory agentso ASA or steroids
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Cardiac SurgeryLong-term post-op
Infective Endocardits
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Cardiac Surgery
Long-term post-opInfective
Endocardits
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Cardiac SurgeryLong-term post-op
ArrhythmiaSick sinus syndrome
SyncopePVCs
Need further monitoring
CHFCondition not relievedInjury to a critical areaHigh cardiac burden before surgery
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Cardiac SurgeryLong-term post-op
Valvular regurgitationEven with good initial
resultsMay need second
surgery
AortopathyProgressive dilation of
ascending aortaCoarctationsClose follow up