Page 69 - Critical Care Notes

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Cardiac Surgeries
Coronary Artery Bypass Graft (CABG)
CABG is an open-heart surgical procedure in which a blood vessel from anoth-
er part of the body, usually the saphenous vein from the leg, is grafted below
the occluded coronary artery so that blood can bypass the blockage. CABG may
be done with the use of a bypass machine (on pump) or without the use of the
machine (off-pump CABG).
Pathophysiology
Surgery is performed on patients with coronary artery disease that causes
blockage to the coronary arteries. Fatty streaks deposited in arterial intima stim-
ulate an inflammatory response that causes proliferation. Proliferation causes
blood vessels to form fibrous caps, and deposits build up as atheromas or
plaques. Plaques pile up, obstructing the blood flow.
Clinical Manifestations
Ischemia: If ischemic episode lasts long enough can cause death to myocardial
cells → MI, angina, chest pain, somatic and visceral pain and discomfort. Atrial
fibrillation a common complication of cardiac surgery.
Diagnostic Tests
■ Health history
■ Routine preoperative lab work including lipid profile, clotting profiles, liver
function tests
■ Type and crossmatch for blood
■ Chest x-ray
■ ECG
■ Exercise treadmill testing
■ Gated SPECT imaging
■ Coronary angiography
■ Echocardiography
■ Electron beam computed tomography (EBCT)
Postoperative Care
■ Common postop care includes maintaining airway patency and monitoring
the patient’s pulmonary status, vital signs, and intake and output.
■ Perform peripheral and neurovascular assessments hourly for first 8 hr.
■ Monitor neurological status.
■ Monitor cardiac status. Provide continuous ECG monitoring. Treat arrhythmias.
■ Titrate drugs: vasopressor and inotropes to optimize cardiac function and BP.
■ Monitor respiratory status including O 2 saturation and ABGs. Patients are
mechanically ventilated on arrival at the ICU.
■ Monitor chest tube drainage and record amount.
CV