الفهرس 
POST-OPERATIVE CARDIOVASCULAR DYSFUNCTIONOnly 14 pages are availabe for public view
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Abstract
R
outine monitoring following cardiac surgery typically includes continuous telemetry, measurement of the arterial blood pressure via an arterial catheter, measurement of the cardiac filling pressures via a pulmonary artery catheter, continuous assessment of the arterial oxygen saturation via pulse oximetry, and continuous measurement of the mixed venous oxygen saturation via an oximetric pulmonary artery catheter. Such monitoring allows instantaneous assessment of cardiopulmonary physiology.
Postoperative cardiac dysfunction is usually suspected when there is unexplained postoperative hypotension, tachycardia, or pulmonary edema. Evaluation consists of reviewing the patient’s telemetry, echocardiography, invasive hemodynamic assessment via a pulmonary artery catheter, and a 12-lead electrocardiogram. These four tests are likely to identify the cause of cardiac dysfunction. A chest x-ray may be helpful if these tests do not find the cause of cardiac dysfunction. The most common causes of cardiac dysfunction following cardiac surgery are mechanical complications, physiologic complications (inadequate preload, excessive afterload, and poor ventricular inotropy), dysrhythmias, and myocardial infarction.
Cardiac surgery using cardiopulmonary bypass can be complicated by vasodilatory (distributive) shock. Most patients with vasodilatory shock respond to intravenous norepinephrine, often at low doses. The pathogenesis of vasodilatory shock following cardiac surgery is uncertain.
Pulmonary complications following cardiac surgery are very common and ranged from 3-16% following CABG and 7-5% following cardiac valvular surgery. These pulmonary complications occure mostly through two major hypothesis.
The lung ischemic hypothesis.
The systemic inflammatory response syndrome hypothesis.
Many factors are implicated in the etiology of impaired pulmonary function but three are responsible for multi-factorial influence.
General anesthesia in which the prolonged supine position produce an upward shift of the diaphragm, combined with relaxation of chest wall and altered chest wall compliance. In addition to these the majority of the drugs used in anesthesia also have repercussion in pulmonary function.
Influence of the extracorporal circulation when ECC initalted the cessation of pulmonary ventilation result in collapsed lung with loss of surfactant and alveolar collapse.
Surgical effect and systemic temperature
Respiratory complication after cardiac surgery include the following lung atelectasis, ARDS, plural effusion, pneumonia, pulmonary embolism, phrenic nerve injury and pneumothorax.
Strategies to reduce the risk of post operative pulmonary complications.
Pre operative strategies through cessation of smoking, control of pulmonary disease like COPD and asthma, treatment of upper respiratory infection and chest physiotherapy.
Intra operative strategies which focus on anesthesia and duration of surgery.
Post operative strategies which include deep breathing and using spirometry, early mobilization, control of pain and prevent venous thromboembolism.
AKI after cardiac surgery is common, although most often mild. The development of any AKI remains a major predictor of adverse outcomes, including progression of CKD. Effective prevention and treatment strategies for AKI after cardiac surgery may be on the horizon, and the discovery, validation, and adaptation of biomarkers of nephron damage may accelerate their development as well as shorten the time for diagnosis. For now, efforts to re- duce AKI following cardiac surgery and its influence on patient morbidity are confined to hemodynamic manipu- lations, close attention to intravenous resuscitation strat- egies including goal-directed therapy and balanced-salt fluid administration, reduced exposure to CPB, and the identification and mitigation of modifiable risk factors.
Neurological complications may follow cardiac surgery. Patients with cerebral complications have higher in-hospital mortality, longer hospitalizations, and a higher rate of requiring discharge to a chronic care facility than those without neurologic sequelae. Early recognition of neurological complications is important. Although treatment is largely supportive, prompt initiation of therapy may prevent worsening of the complication.
Many other postoperative complications may occure at level of blood like thrombosis or bleeding and at level of GIT like acute cholecystitis, acute pancreatitis, liver failure and ileus.